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Texas rates for HCPCS A9569

Technetium Tx-99m Exametazime Labeled Autologous White Blood Cells Diagnostic Per Study Dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.30 / $2,007.08 / $6,186.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.41 / $1,686.54 / $1,748.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.14 / $3,670.30 / $7,323.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,727.68 / $1,727.68 / $1,727.68
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,456.45 / $1,456.45 / $1,456.45
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
$2,606.48 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $2,056.76 / $3,670.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.15 / $1,737.15 / $1,737.15
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,263.70 / $1,889.04 / $1,983.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,707.11 / $2,056.76 / $2,794.11
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,736.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,953.92 / $2,637.79