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Utah rates for HCPCS J2250

Injection, midazolam HCl, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $23.99 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.51 / $1.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.18 / $0.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.17 / $0.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.14 / $0.14