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Utah rates for HCPCS J9017

Injection, arsenic trioxide, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.46 / $9.46 / $9.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.23 / $10.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.48 / $6.84 / $11.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $7.61 / $82.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.32 / $22.98 / $31.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.97 / $11.04 / $11.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15