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Texas rates for HCPCS J0400

Injection, aripiprazole, intramuscular, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.36 / $0.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.28 / $0.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $1.62 / $3.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.39 / $0.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.59 / $0.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.75 / $0.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.75 / $0.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $1.03