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Utah rates for HCPCS J1265

Injection, dopamine HCl, 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,982.44 / $16,982.44 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.23 / $2.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.02 / $1.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.83 / $0.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.83 / $0.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79