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Maine rates for HCPCS A9569

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

Facilitymedian $2,818 · 10th–90th $933–$2,9510%50%10th90th$2,818Professionalmedian $1,738 · 10th–90th $1,660–$1,7380%50%10th$1,738$1.0K$2.0K$5.0K

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
$2,818.38 / $2,818.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $1,096.48 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,995.26 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,089.30
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $1,737.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,737.80 / $2,398.83