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Texas rates for HCPCS J1569

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.77 / $87.85 / $7,479.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.77 / $65.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.58 / $117.89 / $232.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.09 / $51.09 / $51.09
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.65 / $125.72 / $11,984.26
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $71.70 / $86.96
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,344.27 / $1,344.27 / $1,344.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $45.31 / $45.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.05 / $225.65 / $226.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.50 / $47.80 / $66.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.85 / $45.31 / $84.09
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,929.28 / $6,592.66 / $25,743.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $45.31 / $65.45
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.79 / $45.31 / $82.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.25 / $50.75 / $50.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.46 / $46.46 / $61.17