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Rhode Island rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.26 / $48.26 / $48.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $15.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $14.91 / $19.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.85
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $16.63