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Virginia 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
$54.00 / $58.97 / $116.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.12 / $118.41 / $190.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $50.82
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $54.94 / $63.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.16 / $42.57 / $63.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.00 / $42.00 / $42.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.29 / $52.09 / $67.76
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.29 / $52.09 / $67.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $63.53