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Texas rates for HCPCS J1572

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

Facilitymedian $85 · 10th–90th $46–$1740%10%10th90th$85Professionalmedian $52 · 10th–90th $50–$630%50%10th90th$52$50.0$100.0$200.0$500.0

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
$52.48 / $75.86 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $97.72 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $125.89 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $57.54 / $89.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $83.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $75.86 / $457.09
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $58.88