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Idaho rates for HCPCS J0200

Injection, alatrofloxacin mesylate, 100 mg

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $21.38 / $43.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $69.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $24.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $22.91