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Pennsylvania rates for HCPCS J1572

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

Facilitymedian $79 · 10th–90th $54–$1070%20%10th90th$79Professionalmedian $54 · 10th–90th $50–$540%50%10th$54$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $79.43 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $53.70
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $52.48 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $60.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $190.55 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $32.36
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $61.66 / $61.66
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $53.70
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $47.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $41.69 / $77.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $72.44