go back

Utah 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
$1,707.11 / $1,707.11 / $1,707.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,707.11 / $1,707.11 / $1,707.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.25 / $1,748.25 / $1,748.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $1,874.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,953.92 / $2,407.62 / $2,534.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.97 / $1,713.97 / $1,713.97