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Oregon 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 / $127.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $52.73 / $105.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.36 / $80.97 / $97.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.73 / $69.88 / $113.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.93 / $64.48 / $111.52
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.15 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.23 / $60.88 / $75.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $66.18 / $66.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.73 / $54.00 / $165.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $52.94