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Utah rates for HCPCS J0694

Injection Cefoxitin Sodium 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.55 / $75.73 / $137.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.55 / $5.55 / $5.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.21 / $6.76 / $7.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.78 / $4.78 / $4.78