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Minnesota 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
$63.53 / $63.53 / $112.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $52.73 / $105.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.61 / $60.59 / $96.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.20 / $54.00 / $54.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.89 / $61.98 / $162.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.48 / $62.13 / $67.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.94 / $52.94 / $53.42
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.95 / $56.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.83 / $55.76 / $85.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $70.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $70.48