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Illinois 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
$2,488.32 / $4,574.25 / $7,770.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.32 / $2,488.32 / $2,954.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,901.58 / $20,138.88 / $41,847.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,961.60 / $2,961.60 / $2,961.60
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $5,435.00 / $6,560.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $2,928.96