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Maryland 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
$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