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Texas rates for HCPCS J0278

Injection, amikacin sulfate, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $1.24 / $70.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.64 / $1.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $2.76 / $5.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $0.99 / $0.99
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $1.40 / $66.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.63 / $0.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $0.90 / $1.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.63 / $1.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.63 / $1.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.63 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.85