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Pennsylvania rates for HCPCS J1557

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.09 / $146.18 / $189.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $64.31 / $140.59
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.73 / $69.09 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.09 / $66.09 / $69.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.08 / $63.68 / $63.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.09 / $106.62 / $189.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.09 / $64.31 / $189.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.08 / $63.68 / $63.68
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.38 / $52.38 / $60.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.38 / $52.38 / $60.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $71.31 / $109.75