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Arizona rates for HCPCS A9569

Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Facilitymedian $2,754 · 10th–90th $933–$5,8880%5%10%10th90th$2,754Professionalmedian $1,698 · 10th–90th $1,660–$1,7780%50%10th90th$1,698$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,778.28
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $3,630.78 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $11,220.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,884.03 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,137.96 / $3,630.78
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $7,762.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,047.13 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,819.70