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Minnesota 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
$2,056.76 / $2,056.76 / $2,056.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,707.11 / $2,056.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1,308.70 / $4,023.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.40 / $1,138.00 / $1,138.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.80 / $1,207.01 / $1,404.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,612.09
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$698.50 / $1,097.28 / $1,596.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.32 / $2,056.76 / $3,485.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,381.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $3,107.08