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Utah rates for HCPCS J2995

Injection Streptokinase Per 250 000 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.81 / $77.81 / $77.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.81 / $77.81 / $77.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.50 / $79.50 / $79.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.47 / $104.72 / $134.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.16 / $90.69 / $90.69