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Utah rates for HCPCS J9266

Injection, pegaspargase, per single dose vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,988.33 / $23,988.33 / $45,708.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $35,481.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,622.78 / $38,018.94 / $40,738.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $29,512.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $28,183.83 / $37,153.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,018.94 / $47,863.01 / $97,723.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31,622.78 / $31,622.78 / $41,686.94
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18,197.01 / $29,512.09 / $29,512.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,703.96 / $28,183.83 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $28,183.83