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Connecticut rates for HCPCS A9516

Iodine I-123 Sodium Iodide Capsule(S) Diagnostic Per 100 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.36 / $280.87 / $718.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.00 / $108.36 / $302.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.80 / $188.48 / $387.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $106.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.68 / $151.62 / $151.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $106.24 / $117.28