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Utah rates for HCPCS J1558

Injection Immune Globulin (Xembify) 100 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.22 / $17.22 / $17.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.22 / $17.22 / $17.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.68 / $20.38 / $21.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.85 / $14.85 / $37.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $16.63