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Utah rates for HCPCS J1260

Injection, dolasetron mesylate, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.76 / $7.76 / $7.76
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.30 / $12.30 / $13.49