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Maine rates for HCPCS A9509

Iodine I-123 sodium iodide, diagnostic, per mCi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $218.78 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $794.33 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $257.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,187.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $218.78 / $1,862.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,187.76 / $3,162.28