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
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $915 – $1,007 | $4,648 | $11,621 |
| Deaconess Medical Center | $915 – $1,007 | $4,083 | $10,208 |
| Harborview Medical Center | $934 – $1,028 | — | — |
| Highline Medical Center | $1,158 – $1,332 | $1,612 | $5,279 |
| Island Hospital | $1,091 – $1,157 | — | — |
| Kadlec Regional Medical Center | $934 – $1,121 | — | — |
| Mary Bridge Children's Hospital | $915 – $1,007 | $4,648 | $11,621 |
| MultiCare Auburn Medical Center | $915 – $1,007 | $4,648 | $11,621 |
| MultiCare Covington Medical Center | $915 – $1,007 | $4,648 | $11,621 |
| MultiCare Good Samaritan Hospital | $915 – $1,007 | $4,648 | $11,621 |
| MultiCare Valley Hospital | $943 – $1,007 | $4,083 | $10,208 |
| Olympic Medical Center | $1,146 – $1,473 | — | — |
| Overlake Hospital Medical Center & Clinics | $934 – $972 | — | — |
| PeaceHealth Peace Island Medical Center | — | $2,961 | $4,555 |
| PeaceHealth Southwest Medical Cente | $934 – $1,074 | $2,961 | $4,555 |
| PeaceHealth St John Medical Center | $729 – $1,028 | $2,961 | $4,555 |
| PeaceHealth St Joseph Medical Center | $934 – $1,028 | $2,961 | $4,555 |
| PeaceHealth United General Medical Center | — | $2,961 | $4,555 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $934 – $1,121 | — | — |
| Providence Centralia Hospital | $934 – $1,495 | $4,160 | $8,000 |
| Providence Holy Family Hospital | $934 – $1,028 | — | — |
| Providence Regional Medical Center Everett | $934 – $1,028 | — | — |
| Providence St Peter Hospital | — | $4,160 | $8,000 |
| Seattle Children's Hospital | — | $5,225 | $5,225 |
| St Anthony Hospital | $1,179 – $1,356 | $1,605 | $5,279 |
| St Clare Hospital | $1,179 – $1,356 | $1,522 | $5,279 |
| St Elizabeth Hospital | $950 – $1,161 | $1,865 | $5,279 |
| St Francis Community Hospital | $1,158 – $1,332 | $1,657 | $5,279 |
| St Joseph Medical Center | $1,179 – $1,356 | $1,748 | $5,279 |
| St Michael Medical Center | $1,212 – $1,309 | $2,330 | $5,279 |
| Swedish Edmonds Hospital | $934 – $1,121 | — | — |
| Swedish Issaquah | $934 – $1,121 | — | — |
| Swedish Medical Center | $934 – $1,121 | — | — |
| Swedish Medical Center / Cherry Hill | $934 – $1,121 | — | — |
| Tacoma General Allenmore Hospital | $915 – $1,007 | $4,648 | $11,621 |
| University of Washington Medical Ctr | $934 – $1,028 | — | — |
| Virginia Mason Medical Center | $728 – $1,092 | $2,240 | $4,393 |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $915 – $1,025 | — | — |
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