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Utah rates for HCPCS Q9955

Injection, perflexane lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.45 / $13.45 / $13.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.45 / $13.45 / $13.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.25 / $13.25 / $13.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.25 / $13.25 / $13.25