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Idaho 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
$50.82 / $54.00 / $54.64
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $57.92 / $78.14
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.50 / $37.50 / $38.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.12 / $56.12 / $56.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $84.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $64.94