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Washington rates for HCPCS J3355

Injection, urofollitropin, 75 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.65 / $127.65 / $300.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.65 / $127.65 / $127.65
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.15 / $93.02 / $201.04
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.65 / $104.65 / $150.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $253.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $77.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $125.15 / $312.87
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.15 / $91.38 / $166.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.15 / $125.15 / $125.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.15 / $125.15 / $150.18