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Utah rates for HCPCS A9554

Iodine I-125 Sodium Iothalamate M Diagnostic Per Study Dose Up To 10 Microcuries

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.35 / $37.35 / $37.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.35 / $37.35 / $37.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $38.25 / $38.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $40.97 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.75 / $52.68 / $55.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $37.50