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Maine rates for HCPCS Q9967

Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.40 / $96.32 / $545.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $7.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.75 / $130.41 / $648.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.16 / $0.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.23