go back

Maryland 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 / $54.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $69.12
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.12 / $56.12 / $56.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.75 / $57.18 / $59.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $56.12 / $68.73
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.89 / $35.89 / $35.89