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Maine rates for HCPCS A9502

Technetium Tc 99m Tetrofosmin Diagnostic Per Study Dose Up To 40 Millicuries (Special Coverage Instructions Apply. See Mcm: 15

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.96 / $749.17 / $1,157.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $84.93 / $88.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.64 / $263.64 / $263.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $86.98 / $86.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.98 / $86.98 / $86.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $86.98 / $92.75
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
$86.98 / $86.98 / $104.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.00 / $461.34 / $1,157.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $86.98 / $97.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.27 / $85.27 / $123.64