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Michigan 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
$63.51 / $101.98 / $352.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.98 / $101.98 / $108.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.33 / $85.85 / $152.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.75 / $57.63 / $69.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $184.47
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.04 / $114.73 / $500.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.59 / $101.98 / $121.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $116.12