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Florida 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
$51.29 / $52.48 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $52.48 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $53.70 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $58.88
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88