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Idaho rates for HCPCS A9584

Iodine 1-123 Ioflupane Diagnostic Per Study Dose Up To 5 Millicuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,517.36 / $2,517.36 / $7,404.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.32 / $2,643.84 / $2,674.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,643.84 / $2,674.94 / $3,825.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,152.34 / $5,486.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,954.88 / $3,545.86 / $3,693.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $3,628.80