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Tennessee rates for HCPCS A9569

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

Facilitymedian $1,698 · 10th–90th $1,230–$4,3650%20%10th90th$1,698Professionalmedian $1,698 · 10th–90th $1,660–$1,7380%50%10th90th$1,698$1.0K$2.0K$5.0K$10.0K

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
$1,230.27 / $1,230.27 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,691.53 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,165.95 / $6,165.95 / $6,165.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9,332.54 / $9,332.54 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,096.48 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,737.80