go back

Utah rates for HCPCS J1572

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.73 / $52.73 / $88.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $52.73 / $52.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $151.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $59.29