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Washington rates for HCPCS J7121

5% Dextrose In Lactated Ringers Infusion, Up To 1000 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $34.52 / $138.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.95 / $8.14 / $8.27
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $7.95 / $85.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.63 / $6.08 / $9.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $8.14 / $20.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.95 / $7.95 / $8.14
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.38 / $8.61 / $9.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.08 / $6.08 / $6.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.08 / $6.08 / $6.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.98 / $7.98 / $7.98