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Nebraska 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 / $3,552.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,645.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.07 / $1,689.33 / $1,706.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $2,517.39 / $4,214.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.32 / $1,834.52 / $7,712.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,570.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,560.48 / $2,175.15 / $3,818.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.42 / $2,749.66 / $4,124.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,628.27 / $1,713.97 / $2,056.76