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Texas rates for HCPCS J1562

Injection, immune globulin (Vivaglobin), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $10.23 / $19.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.95 / $12.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.52 / $7.73 / $7.73
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.98 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.18 / $10.85 / $14.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.56 / $10.80 / $16.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.25 / $10.85 / $14.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.56 / $10.80 / $16.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.24 / $16.13 / $16.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.25 / $7.25 / $9.78