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New York 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 / $76.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.84 / $50.82 / $63.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.90 / $44.90 / $56.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.87 / $52.94 / $68.56
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.89 / $35.89 / $1,208.00
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.89 / $35.89 / $35.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $38.28 / $54.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.94 / $79.41 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.88 / $60.88 / $72.53
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.10 / $35.10 / $54.00
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.10 / $42.12 / $56.12
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.28 / $38.28 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.98 / $54.00 / $80.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $59.29 / $70.94
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.00 / $54.00 / $56.12