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Missouri 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
$42.57 / $63.53 / $66.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $63.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.12 / $90.00 / $201.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.65 / $50.82 / $63.53
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $56.12 / $278.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $61.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $62.26