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North Carolina 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
$44.54 / $55.42 / $71.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.54 / $44.54 / $67.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.29 / $91.59 / $114.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.47 / $37.47 / $59.82
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 / $63.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.54 / $47.21 / $69.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.11 / $37.11 / $37.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $69.88
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $278.80