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Washington, DC 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 / $54.00 / $54.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.12 / $56.12 / $56.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.46 / $90.46 / $90.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.41 / $52.94 / $68.73