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New York rates for HCPCS J1572

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $51.29 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $52.48 / $63.10
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $38.02
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $35.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $53.70 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $288.40
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $35.48 / $53.70
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $53.70 / $56.23
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $58.88 / $75.86
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.48 / $41.69 / $56.23
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $53.70 / $56.23