go back

Maine rates for HCPCS A9502

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $794.33 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $85.11 / $323.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $87.10 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $154.88
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $104.71
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $794.33 / $1,148.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $87.10 / $123.03