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Utah rates for HCPCS J3260

Injection Tobramycin Sulfate Up To 80 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.75 / $195.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $2.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $2.59 / $3.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.37 / $2.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.37 / $2.37 / $2.37