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Maine rates for HCPCS A9594

Gallium Ga-68 PSMA-11, diagnostic, (UCLA), 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.84 / $776.84 / $776.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.15 / $452.07 / $1,179.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.61 / $776.84 / $776.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.84 / $776.84 / $776.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.84 / $776.84 / $776.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.84 / $776.84 / $930.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.84 / $776.84 / $776.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.61 / $761.61 / $1,142.42