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Ohio 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
$1,516.70 / $2,540.89 / $4,294.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,645.41 / $1,748.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,123.55 / $1,859.66 / $4,010.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,365.59 / $1,627.79 / $2,594.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.49 / $2,260.78 / $2,763.17
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
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $2,619.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.93 / $140.96 / $226.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $2,231.59