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Tennessee rates for HCPCS A9569

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,234.80 / $1,234.80 / $2,560.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,707.11 / $1,707.11
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,215.42 / $5,201.60 / $7,712.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,815.69 / $7,815.69 / $9,255.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,748.25