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Washington rates for HCPCS J3400

Injection Triflupromazine Hcl Up To 20 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.05 / $11.05 / $26.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.79 / $11.05 / $11.05
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $20.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.05 / $11.05 / $44.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.05 / $11.05 / $11.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.11 / $11.11 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $15.60