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New Jersey 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 / $76.14 / $131.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.84 / $52.73 / $54.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.62 / $54.00 / $62.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.73 / $236.56 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $63.53