go back

Louisiana rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $15.36 / $32.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.99 / $18.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.01 / $14.09 / $16.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.71 / $15.71 / $16.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.00 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $19.64