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Maine 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
$2,643.84 / $5,461.11 / $5,461.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,581.63 / $2,643.84 / $2,839.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.19 / $1,686.03 / $4,398.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,643.84 / $2,643.84
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $3,167.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,957.38 / $4,302.51 / $5,461.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,581.63 / $2,643.84 / $2,839.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $3,758.40