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Maryland rates for HCPCS A9516

Iodine I-123 sodium iodide, diagnostic, per 100 mcCi, up to 999 mcCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.66 / $215.63 / $469.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.81 / $108.36 / $138.69
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.90 / $143.90 / $143.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.97 / $150.75 / $235.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $127.48
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.47 / $103.47 / $103.47