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Utah rates for HCPCS Q9957

Injection, perflutren lipid microspheres, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $346.74 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $97.72 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $60.26 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $40.74 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $53.70
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $45.71 / $60.26
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $40.74 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81