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Louisiana 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
$63.53 / $63.53 / $88.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.53 / $63.53 / $63.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.63 / $33.59 / $57.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $57.18 / $58.32
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $63.53