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Minnesota 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
$65.59 / $314.00 / $835.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.98 / $127.48 / $1,432.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $110.22 / $1,064.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.51 / $135.63 / $180.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.65 / $510.02 / $1,226.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.00 / $187.88 / $205.74
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.19 / $466.28 / $966.09
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.00 / $162.00 / $202.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.20 / $123.28 / $215.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $209.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $191.23