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Iowa rates for HCPCS A9569

Technetium Tx-99m Exametazime Labeled Autologous White Blood Cells Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,056.76 / $2,056.76 / $2,434.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $2,056.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.22 / $1,748.25 / $4,363.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $2,333.92 / $2,383.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.32 / $2,056.76 / $4,363.63
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,095.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,560.48 / $2,175.15 / $3,818.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.25 / $2,694.22 / $4,156.47
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,065.02 / $3,251.18 / $3,666.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,885.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,354.04 / $1,713.97 / $1,713.97