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South Dakota rates for HCPCS A9569

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

Facilitymedian $2,042 · 10th–90th $2,042–$2,6300%50%90th$2,042Professionalmedian $1,738 · 10th–90th $1,660–$2,0420%50%10th90th$1,738$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,041.74 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,737.80 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $5,128.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,698.24 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $2,511.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,698.24 / $1,949.84
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24