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Texas rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $115.25 / $678.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $1.04 / $2.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.04 / $1.04
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $4.05 / $152.71
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $4.05
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $1.04 / $80.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.96 / $0.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.24 / $527.24 / $527.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $1.57 / $2.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.14 / $1.58
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.13 / $1.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $2.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.20 / $1.80