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Utah rates for HCPCS J0122

Injection, eravacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.74 / $1.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.35 / $1.35
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.29 / $1.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.29