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Missouri 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
$1,645.41 / $2,056.76 / $7,347.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,707.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.32 / $2,913.75 / $4,781.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,542.57 / $1,542.57 / $2,056.76
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,645.41 / $2,190.07 / $7,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.09 / $1,713.97 / $2,137.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.69 / $1,713.97 / $2,015.62