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Utah rates for HCPCS Q2017

Injection Teniposide 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,485.96 / $2,485.96 / $2,485.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.11 / $2,485.96 / $2,575.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,545.87 / $2,545.87 / $2,545.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $3,078.54 / $3,364.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.26 / $315.11 / $5,041.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.94 / $2,495.94 / $2,495.94