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Texas rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.76 / $868.01 / $1,110.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $513.85 / $707.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.96 / $508.76 / $508.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.98 / $2,423.75 / $2,423.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.86 / $513.85 / $749.35
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.13 / $508.76 / $922.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.71 / $508.76 / $734.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.83 / $508.76 / $877.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.92 / $484.92 / $686.83