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Vermont rates for HCPCS A9516

Iodine I-123 Sodium Iodide Capsule(S) Diagnostic Per 100 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $181.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.16 / $464.16 / $594.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $245.46