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Texas rates for HCPCS J1572

Injection Immune Globulin (Flebogamma) Intravenous Non-Lyophilized (E.G. Liquid) 500mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.12 / $85.02 / $122.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $56.12 / $72.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.40 / $108.11 / $214.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $278.80 / $278.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.74 / $56.12 / $74.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.85 / $47.65 / $66.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.38 / $54.00 / $82.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.65 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.65 / $59.29 / $59.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $71.47