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Utah rates for HCPCS J7196

Injection, antithrombin recombinant, 50 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $138.04 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $151.36 / $204.17
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $141.25