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Utah rates for HCPCS J0456

Injection, azithromycin, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.88 / $50.12 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.51 / $3.16 / $3.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.04 / $3.80
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.04 / $2.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04