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Utah rates for HCPCS J0288

Ampho B Cholesteryl Sulfate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.28 / $13.28 / $13.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.28 / $13.28 / $13.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.04 / $104.25 / $133.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.20 / $16.00 / $16.00