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Maryland 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
$2,659.44 / $2,659.44 / $2,659.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.11 / $1,748.25 / $1,748.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $2,033.00
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 / $1,953.92 / $2,556.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,056.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,482.64 / $1,482.64 / $1,482.64