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Maine rates for HCPCS A9596

Gallium Ga-68 Gozetotide Diagnostic (Illuccix) 1 Millicurie

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.06 / $1,053.85 / $1,053.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.97 / $568.69 / $1,621.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.06 / $1,053.85 / $1,183.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,033.20 / $1,808.10