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Technetium Tc-99m Labeled Autologous White Blood Cells

South Dakota rates for HCPCS A9569

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

Rates data updated July 2026.

Facilitymedian $2,042 · 10th–90th $1,660$3,1620%20%40%10th90th$2,042Professionalmedian $1,738 · 10th–90th $1,698$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
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$2,041.74
Typical High
$2,041.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$2,041.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$2,511.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$2,630.27
Typical High
$5,128.61
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,698.24
Typical High
$1,949.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,511.89
Typical High
$2,511.89
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
United
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$1,698.24
Typical High
$1,949.84
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$1,698.24