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Utah rates for HCPCS J3410

Injection, hydroxyzine HCl, up to 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $74.13 / $467.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $18.62 / $25.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $15.85 / $15.85
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $15.14 / $15.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88