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Arkansas rates for HCPCS J1572

Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.61 / $54.00 / $54.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $54.00 / $54.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.88 / $60.88 / $60.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.23 / $60.88 / $60.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.44 / $54.00 / $54.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29