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Utah rates for HCPCS A9526

Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $724.44 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,096.48
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $758.58 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $758.58