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Montana rates for HCPCS J1572

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

Facilitymedian $65 · 10th–90th $41–$660%50%10th90th$65Professionalmedian $52 · 10th–90th $50–$650%50%10th90th$52$50.0$100.0

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
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $60.26 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $60.26
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $64.57 / $66.07
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $64.57 / $66.07
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $60.26 / $75.86
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $60.26 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48