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Massachusetts 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
$54.00 / $54.00 / $127.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $278.80
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $54.00 / $79.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.58 / $71.20 / $81.34
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.88 / $88.10 / $8,090.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $278.80
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $54.00 / $79.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $54.00 / $74.12