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Texas rates for HCPCS J1620

Injection Gonadorelin Hydrochloride Per 100 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $191.77 / $408.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.09 / $174.34 / $243.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.10 / $192.21 / $192.21
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.71 / $212.61 / $469.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $234.06 / $249.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.46 / $159.46 / $159.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $192.46 / $288.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.46 / $159.46 / $159.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $180.30
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $243.41