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Pennsylvania rates for HCPCS J1459

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.94 / $118.01 / $7,658.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $61.02 / $8,112.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.78 / $55.04 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.65 / $52.65 / $55.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.87 / $50.74 / $50.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.52 / $92.51 / $273.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.94 / $125.07 / $15,699.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $69.68 / $5,973.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.87 / $50.74 / $50.74
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.57 / $47.57 / $55.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.57 / $47.57 / $55.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $56.83 / $87.45