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Tennessee rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $18.79 / $32.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $18.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $85.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.28 / $14.28 / $14.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $19.64