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Maine rates for HCPCS A9567

Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.94 / $110.71 / $197.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $15.72 / $15.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $19.92 / $99,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.32 / $17.32 / $17.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.32 / $17.32 / $17.32
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.94 / $110.71 / $197.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $3.74 / $15.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $20.38 / $30.57