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Idaho rates for HCPCS J2560

Injection Phenobarbital Sodium Up To 120 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.36 / $217.17 / $460.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.36 / $33.11 / $37.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.46 / $30.17 / $30.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $37.71 / $53.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $37.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.32 / $61.04 / $102.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.20 / $36.20 / $37.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.07 / $30.17 / $30.17