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Maine rates for HCPCS A9507

Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,466.84 / $4,466.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,995.26 / $5,495.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $2,041.74 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $8,128.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $5,370.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,248.07 / $7,585.78