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South Carolina 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
$1,686.54 / $1,686.54 / $6,818.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,559.34 / $1,686.54 / $1,707.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.28 / $693.28 / $693.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,742.80 / $2,056.76 / $2,383.28
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 / $1,748.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$708.40 / $1,686.54 / $2,262.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,713.97