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Kentucky 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 / $50.82 / $108.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $52.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.47 / $66.18 / $105.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.70 / $56.12 / $56.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.34 / $38.81 / $64.68
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.49 / $32.34 / $61.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.77 / $54.00 / $80.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29