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Arizona rates for HCPCS A9569

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,665.98 / $1,665.98 / $1,665.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.95 / $3,357.00 / $5,317.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,172.34 / $1,563.14 / $7,571.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,665.98 / $2,149.31 / $7,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,719.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,713.97