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New Hampshire 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
$54.00 / $54.00 / $66.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.43 / $94.76 / $245.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $54.00 / $54.00
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $52.94 / $59.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $36.81 / $46.84