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Utah rates for HCPCS J1364

Injection, erythromycin lactobionate, per 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.95 / $74.95 / $185.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.95 / $74.95 / $74.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.69 / $94.15 / $118.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.62 / $64.62 / $64.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.04 / $143.31 / $202.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.39 / $64.62 / $64.62