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Arizona rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.94 / $1.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $1.25 / $1.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.31 / $2.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.55 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.05