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Hawaii rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.56 / $27.56 / $27.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.82 / $20.82 / $20.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.32 / $17.80 / $20.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.63 / $17.11 / $22.28
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.98 / $16.73 / $18.39