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North Dakota 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
$50.82 / $50.82 / $97.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $63.53 / $63.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.59 / $55.87 / $56.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.25 / $55.78 / $56.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.94 / $52.94 / $60.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $53.48 / $66.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $56.12 / $86.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $59.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $59.29