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Maine rates for HCPCS A9515

Choline C-11, diagnostic, per study dose up to 20 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,996.31 / $2,505.85 / $6,537.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,100.00 / $5,610.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,100.00 / $5,100.00 / $5,100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,000.00 / $5,100.00 / $7,250.00