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Nebraska 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
$2,488.32 / $3,400.88 / $6,799.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,488.32 / $2,813.52 / $4,694.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.45 / $500.30 / $975.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,714.63 / $3,393.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,388.02 / $2,961.60 / $11,106.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,468.00 / $2,592.00 / $3,110.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,637.24 / $3,168.84 / $4,513.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,964.04 / $2,964.04 / $2,964.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,462.40 / $2,592.00 / $3,110.40