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Utah rates for HCPCS J3105

Injection, terbutaline sulfate, up to 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $26.92 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $2.82 / $3.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $3.09 / $3.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.95 / $7.41 / $7.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45