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Massachusetts rates for HCPCS A9569

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

Facilitymedian $3,162 · 10th–90th $1,738–$6,0260%10%10th90th$3,162Professionalmedian $1,738 · 10th–90th $1,660–$2,4550%50%10th90th$1,738$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $2,041.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,691.53 / $6,165.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $9,332.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,981.07 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,715.35 / $7,585.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,445.44 / $7,079.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,818.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,691.53 / $6,165.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,047.13 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,737.80 / $2,089.30