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New Hampshire rates for HCPCS A9569

Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose

Facilitymedian $2,570 · 10th–90th $1,445–$4,6770%10%10th90th$2,570Professionalmedian $1,738 · 10th–90th $1,660–$2,8840%50%10th90th$1,738$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,737.80 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $3,235.94 / $4,677.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,737.80 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,715.35 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $3,311.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,737.80