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Utah rates for HCPCS Q9992

Injection, buprenorphine extended-release (Sublocade), greater than 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,754.23 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,801.89 / $7,079.46
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,089.30 / $2,089.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,995.26 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26