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Utah rates for HCPCS Q9950

Injection Sulfur Hexafluoride Lipid Microspheres Per Ml(Reinstated 01/01/2016) Low Osmolar Contrast Material 350-399 Mg/Ml Iodine Concentration Per Ml (Del 12/31/07)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.57 / $21.57 / $234.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.57 / $21.57 / $21.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.85 / $26.72 / $28.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.59 / $18.59 / $18.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.59 / $18.59 / $18.59