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Washington rates for HCPCS J0696

Injection, ceftriaxone sodium, per 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $16.88 / $115.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $1.84 / $7.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $1.33 / $123.74
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.48 / $1.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.53
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.56 / $1.29
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $1.33 / $1.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.51 / $1.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43