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Oklahoma 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
$51.46 / $51.46 / $102.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.46 / $51.46 / $51.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.74 / $54.00 / $54.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.59 / $54.03 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $52.94 / $59.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $52.94 / $59.29