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Texas rates for HCPCS J7201

Injection Factor Ix Fc Fusion Protein (Recombinant) Alprolix 1 I.U. (Desc Revised 1/1/2017)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.59 / $6.30 / $8.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.63 / $5.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $6.15 / $12.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.59 / $3.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.59 / $3.59
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $5.13 / $5.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.72 / $3.59 / $6.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.39 / $3.59 / $5.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.36 / $3.59 / $6.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.55 / $3.55 / $5.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.59 / $3.59 / $3.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.58 / $3.58 / $4.84