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Maine rates for HCPCS A9539

Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $30.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $28.84 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $57.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $31.62 / $38.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.90 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $38.02 / $54.95