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Michigan 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
$4,897.79 / $11,481.54 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,011.87 / $5,248.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $7,762.47 / $13,489.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,128.61 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $9,120.11 / $28,183.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $9,772.37 / $13,182.57
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,495.41