Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS J2278 (Prialt) Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, ziconotide, 1 microgram
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Drugs, Administered by Injection |
| Common Place of Service | None 11 - Office |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for J2278 |
| Medicare Payment Limit | $10.14  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
| Related NDC Codes | • 70720-0720-10 - PRIALT (1X1ML,SINGLE-USE VIAL) 100 MCG/1 ML • 70720-0722-10 - PRIALT (1X5ML,SINGLE-USE VIAL) 100 MCG/1 ML • 70720-0723-10 - PRIALT (1X20ML,SINGLE-USE VIAL) 25 MCG/1 ML |
National average reimbursement for HCPCS J2278 by major payers:
$10.14
$10.00
$10.52
$10.31
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS J2278.
HCPCS J2278
5 of 25 sample ratesHigher to lower in this preview
Sutter Valley Hospitals, Sutter Health Sacramento Sierra Region
Sutter Valley Hospitals
$26.29Published rateRegions Hospital
Group Health Plan Inc
$11.64Published rateColumbia Vamc
$9.77Published rateHartford Hospital
Hartford Healthcare Medical Group Specialists PLLC
$9.77Published rateKamil Lupicki
New York City Health And Hospitals Corporation
$6.46Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS J2278 vs. Other Drugs, Administered by Injection Codes
The HCPCS J2278 code is part of the Drugs Administered Other than Oral Method services used for Drugs, Administered by Injection. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J2278 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 70720-0720-10-NDC | Moderate | PRIALT (1X1ML,SINGLE-USE VIAL) 100 MCG/1 ML |
| 70720-0722-10-NDC | Moderate | PRIALT (1X5ML,SINGLE-USE VIAL) 100 MCG/1 ML |
| 70720-0723-10-NDC | Moderate | PRIALT (1X20ML,SINGLE-USE VIAL) 25 MCG/1 ML |
| J2278-HCPCS | Low | Injection, ziconotide, 1 microgram |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J2278. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J2278 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS J2278) and we'll show you how you compare in 15 minutes or less.