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Utah rates for HCPCS J7631

Cromolyn Sodium Inhalation Solution Administered Through Dme Unit Dose Form Per 10 Milligrams (Special Coverage Instructions Apply. See Mcm: 2100.5)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.51 / $0.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $7.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.25 / $0.35 / $2.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.44 / $2.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.44