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Minnesota 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
$2,041.74 / $2,041.74 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $2,041.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $2,818.38 / $6,309.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,258.93 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,754.23
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,148.15 / $1,659.59
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,570.40 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,041.74 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $3,090.30