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Maryland rates for HCPCS A9515

Choline C-11 Diagnostic Per Study Dose Up To 20 Millicuries (Reinstated 01/01/2017) Supply Of Radiopharmaceutical Diagnostic Imaging Agent Technitium Tc-99m Pentetate Per Mci (Del 12/31/2005)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,980.00 / $5,100.00 / $5,100.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.00 / $4,800.00 / $4,800.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,062.94 / $2,062.94 / $2,062.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,845.00 / $5,700.00 / $6,555.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,000.00 / $5,275.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.07 / $19.07 / $19.07