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Utah rates for HCPCS A9569

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

Facilitymedian $1,698 · 10th–90th $1,698–$2,5120%50%90th$1,698Professionalmedian $1,698 · 10th–90th $1,698–$2,0420%50%90th$1,698$50.0$100.0$200.0$500.0$1.0K$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $1,862.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,089.30 / $3,019.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $2,570.40
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,949.84 / $2,137.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $1,698.24