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Texas rates for HCPCS J1595

Injection, glatiramer acetate, 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $76.88 / $144.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $61.50 / $83.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.90 / $242.14 / $499.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.50 / $50.50 / $50.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,199.84 / $2,551.37 / $2,813.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.71 / $75.00 / $1,939.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.25 / $1,467.24 / $2,814.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.50 / $63.75 / $101.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $2,329.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $62.50
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $57.50 / $77.63