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Hawaii 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
$79.73 / $79.73 / $79.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.73 / $79.73 / $79.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.43 / $60.43 / $60.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.04 / $59.29 / $79.41
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $42.10 / $53.57