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Utah rates for HCPCS J2997

Injection, alteplase recombinant, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $562.34 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $131.83 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $173.78 / $331.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $97.72 / $109.65
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $95.50 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33