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Utah rates for HCPCS J0841

Injection, crotalidae immune F(ab')2 (equine), 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $5,754.40 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $5,011.87 / $5,754.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,290.87 / $3,801.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $4,897.79
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,047.13 / $5,888.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79