go back

Wisconsin rates for HCPCS A9569

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

Facilitymedian $1,660 · 10th–90th $933–$2,3440%20%10th90th$1,660Professionalmedian $1,698 · 10th–90th $1,660–$4,1690%50%10th90th$1,698$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$1,659.59 / $1,659.59 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,995.26 / $2,089.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,698.24 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,202.26 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,818.38 / $3,235.94
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,737.80 / $2,089.30
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.51 / $1,698.24
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,659.59 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $1,862.09
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $2,511.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $4,466.84 / $6,606.93
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $6,165.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,187.76 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,047.13 / $2,454.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $2,238.72