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New Jersey 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
$1,748.25 / $1,748.25 / $4,519.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,707.11 / $1,748.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,559.34 / $1,748.25 / $2,017.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $2,254.37 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.07 / $1,748.25 / $1,960.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,958.04