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Utah rates for HCPCS A9584

Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,581.63 / $2,877.05 / $3,496.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,581.63 / $2,581.63 / $2,581.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,643.84 / $2,643.84 / $2,643.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,203.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,954.88 / $3,641.00 / $3,832.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,592.00 / $2,592.00 / $2,592.00