go back

Pennsylvania rates for HCPCS J1562

Injection, immune globulin (Vivaglobin), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.73 / $13.19 / $21.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.73 / $7.73 / $12.24
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.16 / $11.95 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.95 / $11.95 / $11.95
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.73 / $13.06 / $22.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.73 / $7.73 / $17.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.40 / $16.13 / $19.89