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Utah rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $24.55 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $6.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $1.58 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.32 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.38
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.05 / $1.20
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.95 / $1.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05