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Pennsylvania rates for HCPCS J1566

Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.78 / $173.20 / $248.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $82.52 / $5,512.65
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.67 / $85.49 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.77 / $81.77 / $85.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.33 / $78.79 / $78.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $78.79 / $78.79
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$249.13 / $249.13 / $249.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.52 / $139.46 / $248.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $87.53 / $248.37
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.33 / $78.79 / $78.79
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $78.79 / $78.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.59 / $73.59 / $85.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.59 / $73.59 / $85.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $88.26 / $116.08