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Oregon rates for HCPCS A9569

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

Facilitymedian $1,950 · 10th–90th $1,698–$2,3440%50%10th90th$1,950Professionalmedian $1,698 · 10th–90th $1,413–$2,0420%50%10th90th$1,698$100.0$200.0$500.0$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
$1,698.24 / $1,949.84 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,698.24 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $3,467.37 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,570.88 / $4,897.79
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,862.09 / $2,454.71
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,698.24 / $1,949.84
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,041.74 / $3,890.45
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,737.80 / $3,388.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,905.46 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,949.84