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Alaska rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $0.86 / $3.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.87 / $0.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.24 / $1.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.24 / $1.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.41 / $0.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.58 / $2.12