go back

Alaska rates for HCPCS J1572

Injection Immune Globulin (Flebogamma) Intravenous Non-Lyophilized (E.G. Liquid) 500mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.91 / $84.91 / $300.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $85.77 / $105.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.65 / $122.65 / $122.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.59 / $31.59 / $45.13
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.94 / $88.94 / $139.77
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.94 / $122.65 / $209.65
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.29 / $79.41 / $158.82