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Maine 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
$147.38 / $147.38 / $158.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.31 / $68.17 / $177.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.38 / $147.38 / $158.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $158.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.79 / $52.94 / $76.76