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New Hampshire rates for HCPCS J1572

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

Facilitymedian $74 · 10th–90th $60–$1260%10%20%10th90th$74Professionalmedian $54 · 10th–90th $43–$540%50%10th$54$50.0$100.0$200.0

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
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $60.26 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $53.70 / $53.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $79.43 / $125.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $114.82 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $58.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $52.48 / $58.88