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Tennessee 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
$52.73 / $68.55 / $104.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $52.73 / $52.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.53 / $63.53 / $63.53
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $278.80 / $278.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29