Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
RRX TC-99M EXAMETAZINE AUTOLOGOUS WBC'S PER DOSE
Summit, WI
See all hospitals reporting HCPCS A9569 →Price type
Aurora Medical Center Summit’s median price of $5.0k is 189% above the median hospital's median price ($1.7k), higher than 92% of the 1,610 hospitals reporting HCPCS A9569. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 21 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare charter fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 2 | UnitedHealthcare exchange fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 3 | UnitedHealthcare hmo fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 4 | UnitedHealthcare nexus fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 5 | Aetna hmo fee schedule · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 6 | Anthem blue priority fee schedule · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 7 | Anthem blue preferred fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 8 | Cigna ppo-gppo fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 9 | Healthpartners employee trust fund percent of total billed charges · outpatientfrom % of charges | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 10 | Molina commercial percent of total billed charges · outpatientfrom % of charges | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 11 | Healthpartners broad percent of total billed charges · inpatientfrom % of charges | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 12 | Healthpartners broad percent of total billed charges · outpatientfrom % of charges | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 13 | Healthpartners robin percent of total billed charges · outpatientfrom % of charges | $6.2k | $6.2k | — | — | — | $6.2k – $6.2k |
| 14 | Aetna ppo percent of total billed charges · inpatientfrom % of charges | $6.9k | $6.9k | — | — | — | $6.9k – $6.9k |
| 15 | Aetna ppo percent of total billed charges · outpatientfrom % of charges | $6.9k | $6.9k | — | — | — | $6.9k – $6.9k |
| 16 | UnitedHealthcare ppo percent of total billed charges · inpatientfrom % of charges | $7.0k | $7.0k | — | — | — | $7.0k – $7.0k |
| 17 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $7.0k | $7.0k | — | — | — | $7.0k – $7.0k |
| 18 | Cigna ppo percent of total billed charges · inpatientfrom % of charges | $7.0k | $7.0k | — | — | — | $7.0k – $7.0k |
| 19 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $7.0k | $7.0k | — | — | — | $7.0k – $7.0k |
| 20 | Anthem ppo percent of total billed charges · inpatientfrom % of charges | $7.1k | $7.1k | — | — | — | $7.1k – $7.1k |
| 21 | Anthem ppo percent of total billed charges · outpatientfrom % of charges | $7.1k | $7.1k | — | — | — | $7.1k – $7.1k |
Last updated: Nov 21, 2025
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