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Massachusetts 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 / $2,372.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,748.25 / $1,953.92
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.10 / $2,415.62 / $3,801.02
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $7,815.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,305.46 / $3,948.66 / $7,273.24
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.32 / $1,643.71 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,819.93
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,215.42 / $2,215.42 / $5,201.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $7,815.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,570.96