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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
$5,210.58 / $5,210.58 / $5,210.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,007.79 / $2,520.27 / $6,575.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,108.41 / $5,210.57 / $5,210.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,210.58 / $5,210.58 / $5,210.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,210.58 / $5,210.58 / $5,210.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,210.58 / $5,210.58 / $6,242.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,210.58 / $5,210.58 / $5,210.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,108.41 / $5,108.41 / $7,407.19