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Alaska rates for HCPCS J0696

Injection, ceftriaxone sodium, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $57.78 / $351.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.80 / $5.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $7.96 / $114.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $1.38
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $2.24 / $3.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $2.24 / $5.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.65 / $0.87