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Maine rates for HCPCS A9568

Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.00 / $1,105.00 / $1,105.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$719.98 / $975.62 / $2,565.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.01 / $1,157.01 / $99,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.90 / $1,066.90 / $1,066.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,479.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.00 / $1,105.00 / $1,105.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,235.00 / $1,790.75