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Ohio rates for HCPCS A9569

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

Facilitymedian $2,344 · 10th–90th $1,000–$4,5710%5%10%10th90th$2,344Professionalmedian $1,698 · 10th–90th $1,380–$2,0890%50%10th90th$1,698$20.0$100.0$500.0$2.0K$10.0K

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
$1,659.59 / $2,691.53 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,089.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,737.80 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $4,365.16 / $5,011.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,041.74
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,754.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $128.82 / $186.21
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,238.72 / $3,890.45
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,862.09