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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
$217.08 / $217.08 / $1,844.67
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
$792.50 / $792.50 / $99,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.26 / $143.26 / $143.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.26 / $143.26 / $143.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.67 / $1,844.67 / $2,210.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.08 / $217.08 / $1,844.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.67 / $2,170.19 / $3,255.30