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Utah rates for HCPCS A9509

Iodine I-123 sodium iodide, diagnostic, per mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $229.09 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $60.26 / $2,454.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $275.42
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $204.17 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76