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Colorado rates for HCPCS A9569

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,645.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,953.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.90 / $2,991.23 / $5,484.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.76 / $1,559.34 / $1,748.25
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 / $2,423.98
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,645.41 / $1,748.25 / $2,806.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,497.00 / $3,497.00 / $3,497.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,713.97