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Indiana rates for HCPCS A9584

Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,369.28 / $5,344.15 / $5,923.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.32 / $2,488.32 / $2,581.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,388.02 / $3,259.62 / $5,961.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,019.60 / $2,160.00 / $3,067.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,297.02 / $4,510.08 / $4,976.64
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 / $3,110.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $3,462.39