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Maine rates for HCPCS A9501

Technetium Tc-99m teboroxime, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $117.49 / $151.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $50.12 / $95,499.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $131.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $117.49 / $151.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65