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Utah rates for HCPCS Q9963

High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.51 / $38.02 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $32.36 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.32 / $0.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.28
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.23 / $0.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.22 / $0.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.22 / $0.22