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Utah rates for HCPCS J3410

Injection Hydroxyzine Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.73 / $46.74 / $110.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.73 / $17.73 / $17.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.40 / $18.69 / $25.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30