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Ohio 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
$99.63 / $283.50 / $689.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.98 / $101.98 / $155.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.36 / $248.60 / $690.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $217.02 / $344.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.67 / $106.67 / $112.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.67 / $106.67 / $106.67
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 / $127.48
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $87.39 / $403.04
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $153.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $139.16