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Indiana rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.42 / $0.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
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 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.30