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Pennsylvania rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $34.89 / $45.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.99 / $37.26
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.69 / $16.11 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.41 / $15.41 / $16.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.84 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.06 / $29.67 / $45.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $15.06 / $45.33
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.84 / $14.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.98 / $12.98 / $15.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.98 / $12.98 / $15.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $16.63 / $21.53