go back

Utah rates for HCPCS J0791

Injection, crizanlizumab-tmca, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $186.21 / $194.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $239.88 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $134.90 / $134.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $128.82 / $154.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82