go back

North Carolina 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
$1,559.33 / $2,662.08 / $2,703.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.34 / $1,559.34 / $1,748.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.66 / $1,276.67 / $1,404.34
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 / $2,056.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.40 / $1,559.34 / $2,311.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.59 / $977.59 / $977.59
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,453.69 / $2,560.26 / $3,043.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,228.16
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,215.42 / $2,606.48 / $5,201.60
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,815.69 / $7,815.69 / $9,255.42