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Kentucky 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
$1,645.41 / $1,645.41 / $9,148.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,707.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,940.34 / $2,021.19 / $2,600.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.70 / $1,160.76 / $1,365.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,257.01 / $2,344.51 / $2,372.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.33 / $1,370.33 / $1,370.33
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 / $2,612.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,835.66