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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
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $6.92 / $11.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $8.13 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $33.88 / $48.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $10.72
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.46 / $6.76 / $56.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $8.13 / $12.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41