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Utah rates for HCPCS J3101

Injection, tenecteplase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $18,620.87 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $234.42 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $288.40 / $575.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $204.17 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $173.78 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21