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Texas rates for HCPCS J1568

Injection, immune globulin, (Octagam), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.53 / $78.88 / $117.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $48.00 / $66.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.34 / $165.40 / $326.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.40 / $54.40 / $54.40
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,797.32 / $1,797.32 / $1,797.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.83 / $47.52 / $47.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.07 / $237.65 / $240.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.04 / $48.38 / $70.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.29 / $47.53 / $89.23
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.15 / $47.52 / $68.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.93 / $47.52 / $86.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $53.23 / $53.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.38 / $49.30 / $64.17