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Texas rates for HCPCS J7121

5% Dextrose In Lac Ringers

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.86 / $34.50 / $166.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.66 / $7.86 / $10.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $12.13 / $25.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.52 / $5.52 / $5.52
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.71 / $27.75 / $29.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $85.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.86 / $13.01 / $79.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.19 / $7.19 / $7.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.66 / $8.14 / $11.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $7.98 / $7.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $10.77