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Texas rates for HCPCS J0572

Buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.76 / $5.49 / $18.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.76 / $3.85 / $4.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.94 / $7.22 / $14.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.84 / $0.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.26 / $4.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.85 / $4.00 / $4.70
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.53 / $4.00 / $4.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.85 / $4.00 / $4.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $4.00 / $4.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.45 / $6.36 / $6.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $5.40