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Illinois 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
$50.82 / $101.64 / $170.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $63.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.65 / $116.10 / $469.25
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
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.61 / $99.58 / $131.84
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $59.29