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Utah rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.19 / $19.19 / $31.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.19 / $19.19 / $19.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $21.06 / $25.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.71 / $16.54 / $16.54