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Maine rates for HCPCS A9504

Technetium Tc-99m Apcitide Diagnostic Per Study Dose Up To 20 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $425.00 / $425.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $412.82 / $99,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.81 / $432.81 / $432.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $475.00 / $569.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $425.00 / $425.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $500.00 / $725.00