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Oregon rates for HCPCS A9569

Technetium Tx-99m Exametazime Labeled Autologous White Blood Cells Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,953.92 / $1,953.92 / $1,953.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.11 / $1,707.11 / $1,707.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,496.50 / $3,496.50 / $3,496.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,886.37 / $4,482.76 / $4,836.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $2,262.44 / $3,670.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,352.42 / $1,352.42 / $2,600.80
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,953.92 / $2,157.13 / $3,595.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $2,441.17 / $3,670.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $2,261.48 / $3,419.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,953.92 / $1,953.92 / $1,953.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,971.07