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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
$2,570.40 / $3,311.31 / $3,467.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,570.40 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $2,630.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $3,235.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,890.45
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40