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Maine 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
$201.05 / $217.10 / $666.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.48 / $328.48 / $328.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $108.35 / $108.35
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $129.83
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.41 / $249.22 / $972.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.81 / $108.36 / $121.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $159.36