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Maryland rates for HCPCS A9582

Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,248.07 / $6,165.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $4,897.79 / $5,888.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,888.44 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,165.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07