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Connecticut 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
$54.00 / $81.09 / $177.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.94 / $80.48 / $158.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $54.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.23 / $60.88 / $70.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.65 / $52.94 / $59.29