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Utah rates for HCPCS J0278

Injection, amikacin sulfate, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.74 / $1.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.81 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.63 / $1.41
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.63 / $0.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62