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Maine rates for HCPCS A9582

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,248.07 / $5,248.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,691.53 / $7,413.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,248.07 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $5,248.07 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $9,332.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $6,309.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,248.07 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,248.07 / $7,413.10