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South Carolina 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
$52.09 / $52.09 / $210.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.54 / $52.09 / $72.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.93 / $72.38 / $127.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $63.53 / $76.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.30 / $57.30 / $70.31
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.81 / $62.81 / $62.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29