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Texas rates for HCPCS J1575

Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $33.88 / $44.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $23.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.30 / $30.90 / $58.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $18.20 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $21.88 / $44.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $18.20 / $20.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $17.78 / $18.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $26.30 / $60.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $18.62 / $19.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $20.42 / $20.42