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Georgia 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
$52.73 / $52.73 / $52.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.09 / $52.73 / $56.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.12 / $91.36 / $205.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $60.35 / $60.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $55.59 / $108.95
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.77 / $55.07 / $55.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $63.53