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Utah rates for HCPCS J2560

Injection, phenobarbital sodium, up to 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.99 / $202.85 / $833.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.99 / $34.99 / $194.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.97 / $42.02 / $46.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.28 / $82.45 / $147.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17