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New York 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
$1,419.16 / $1,645.41 / $1,748.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.16 / $1,707.11 / $1,748.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.26 / $832.26 / $1,040.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,587.01 / $1,713.97 / $1,713.97
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,179.08 / $2,179.08 / $2,179.08
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.08 / $2,179.08 / $2,179.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,606.12 / $1,654.30 / $1,748.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,832.17
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,486.01 / $1,748.25 / $1,748.25
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,816.81 / $1,816.81
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,816.81 / $1,816.81
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $1,654.30 / $1,748.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,477.77
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,816.81