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Utah rates for HCPCS A9596

Gallium Ga-68 gozetotide, diagnostic, (Illuccix), 1 mCi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,023.29 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,041.74 / $3,715.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,174.90 / $1,479.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,174.90 / $1,230.27
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $602.56 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48