go back

Texas rates for HCPCS A9569

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

Facilitymedian $3,162 · 10th–90th $1,445–$6,1660%10%20%10th90th$3,162Professionalmedian $1,698 · 10th–90th $1,660–$1,9500%50%10th90th$1,698$50.0$200.0$1.0K$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,089.30 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $3,630.78 / $6,918.31
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $4,073.80 / $11,748.98
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
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,041.74 / $6,165.95
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,041.74 / $5,495.41
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,047.13 / $1,698.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84