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Kansas rates for HCPCS J1572

Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $50.12 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $50.12 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $69.18 / $69.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $51.29 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $61.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $63.10