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Utah rates for HCPCS A9596

Gallium Ga-68 Gozetotide Diagnostic (Illuccix) 1 Millicurie

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,029.07 / $1,029.07 / $1,029.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,016.67 / $1,029.07 / $1,066.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.85 / $1,053.85 / $1,053.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,613.97 / $2,054.76 / $2,949.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.84 / $1,451.35 / $1,527.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.20 / $1,033.20 / $1,033.20