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Utah rates for HCPCS A9582

Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,128.61 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $5,248.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $8,128.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $7,762.47
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61