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Washington, DC 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
$1,748.25 / $1,748.25 / $2,785.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,645.41
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,660.83 / $1,660.83 / $2,410.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,777.97