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Utah rates for HCPCS A9516

Iodine I-123 Sodium Iodide Capsule(S) Diagnostic Per 100 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.81 / $319.76 / $497.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.81 / $105.81 / $105.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.36 / $108.36 / $108.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.00 / $243.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.24 / $106.24 / $106.24