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Maine 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
$213.80 / $323.59 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $104.71 / $107.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $194.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $128.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $323.59 / $977.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $107.15 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $162.18