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Texas rates for HCPCS J2315

Injection Naltrexone Depot Form 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.28 / $11.83 / $5,903.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.28 / $5.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.29 / $8.33 / $16.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.49 / $4.49 / $4.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.00 / $4.24 / $4.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
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
$2.14 / $4.28 / $6.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.18 / $4.24 / $7.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $4.24 / $6.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.97 / $4.24 / $7.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.24 / $4.24 / $4.24
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.12 / $4.12 / $5.72