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Maine rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.14 / $70.14 / $130.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.97 / $2.97 / $2.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.14 / $70.14 / $130.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.39