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Indiana 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 / $127.06 / $228.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $50.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.12 / $105.88 / $140.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.70 / $56.12 / $75.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.00 / $34.00 / $45.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.15 / $34.00 / $54.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $99.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.53 / $54.00 / $148.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $63.53