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Texas rates for HCPCS J7316

Injection Ocriplasmin 0.125 Mg (Code Was Deleted01/01/03 But Reinstated On 01/01/14) Sodium Hyaluronate 5 Mg For Intra-Articular Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$948.16 / $1,069.05 / $2,275.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.16 / $971.86 / $1,360.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,046.93 / $1,046.93 / $1,046.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.93 / $1,046.93 / $1,046.93
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,690.00 / $5,234.64 / $5,234.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$971.86 / $1,046.93 / $1,473.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.90 / $888.90 / $888.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$971.86 / $1,046.93 / $1,389.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.93 / $1,046.93 / $1,046.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.20 / $1,185.20 / $1,185.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.93 / $1,046.93 / $1,413.36