go back

Maine rates for HCPCS J1572

Injection, immune globulin, (Flebogamma/Flebogamma Dif), intravenous, nonlyophilized (e.g., liquid), 500 mg

Facilitymedian $105 · 10th–90th $62–$2880%20%10th90th$105Professionalmedian $52 · 10th–90th $50–$540%50%10th90th$52$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $53.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $104.71 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $52.48 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $61.66 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $79.43
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $52.48 / $77.62