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Texas rates for HCPCS J3355

Injection, urofollitropin, 75 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.14 / $135.47 / $288.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.14 / $123.15 / $166.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.18 / $663.30 / $663.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.54 / $123.15 / $176.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.94 / $107.30 / $112.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $176.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $107.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.15 / $125.15 / $125.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $85.63