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Utah rates for HCPCS J2765

Injection, metoclopramide HCl, up to 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.51 / $23.44 / $50.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.55 / $1.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.00 / $1.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.10 / $1.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.20