HCPCS A9569
Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
Current codeMyocardial Perfusion Scan39 hospitals with prices
What Washington hospitals publish for this code
Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.
| Hospital | Medicaid managed care rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | $4,648 | $11,621 |
| Deaconess Medical Center | — | $4,083 | $10,208 |
| Harborview Medical Center | — | — | — |
| Highline Medical Center | — | $1,612 | $5,279 |
| Island Hospital | $1,091 | — | — |
| Kadlec Regional Medical Center | — | — | — |
| Mary Bridge Children's Hospital | — | $4,648 | $11,621 |
| MultiCare Auburn Medical Center | — | $4,648 | $11,621 |
| MultiCare Covington Medical Center | — | $4,648 | $11,621 |
| MultiCare Good Samaritan Hospital | — | $4,648 | $11,621 |
| MultiCare Valley Hospital | — | $4,083 | $10,208 |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| PeaceHealth Peace Island Medical Center | — | $2,961 | $4,555 |
| PeaceHealth Southwest Medical Cente | $972 | $2,961 | $4,555 |
| PeaceHealth St John Medical Center | $729 – $981 | $2,961 | $4,555 |
| PeaceHealth St Joseph Medical Center | $981 | $2,961 | $4,555 |
| PeaceHealth United General Medical Center | — | $2,961 | $4,555 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | — | — |
| Providence Centralia Hospital | — | $4,160 | $8,000 |
| Providence Holy Family Hospital | — | — | — |
| Providence Regional Medical Center Everett | — | — | — |
| Providence St Peter Hospital | — | $4,160 | $8,000 |
| Seattle Children's Hospital | — | $5,225 | $5,225 |
| St Anthony Hospital | — | $1,605 | $5,279 |
| St Clare Hospital | — | $1,522 | $5,279 |
| St Elizabeth Hospital | $897 – $1,093 | $1,865 | $5,279 |
| St Francis Community Hospital | — | $1,657 | $5,279 |
| St Joseph Medical Center | — | $1,748 | $5,279 |
| St Michael Medical Center | — | $2,330 | $5,279 |
| Swedish Edmonds Hospital | — | — | — |
| Swedish Issaquah | — | — | — |
| Swedish Medical Center | — | — | — |
| Swedish Medical Center / Cherry Hill | — | — | — |
| Tacoma General Allenmore Hospital | — | $4,648 | $11,621 |
| University of Washington Medical Ctr | — | — | — |
| Virginia Mason Medical Center | — | $2,240 | $4,393 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | — | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Hospital outpatient payment (national)
- $934 (APC 0776)
- Surgery center payment (national)
- $934