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Utah rates for HCPCS J9208

Ifosfamide 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.24 / $29.24 / $553.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.96 / $31.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.33 / $35.13 / $39.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.20 / $25.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.50 / $30.00 / $39.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.72 / $34.15 / $35.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.20 / $25.20 / $25.20