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South Carolina 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
$194.25 / $423.47 / $956.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.12 / $104.53 / $105.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.19 / $51.19 / $51.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $99.98 / $119.98
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.80 / $104.53 / $169.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.53 / $122.94 / $130.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $106.24