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Texas rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $26.12 / $51.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.11 / $17.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.08 / $20.87 / $42.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.38 / $22.38 / $22.38
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $12.80 / $106.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $6.05 / $6.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
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
$4.43 / $8.65 / $12.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $9.60 / $28.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $6.05 / $8.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $11.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.17 / $12.80 / $15.78