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Virginia 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
$53.70 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $52.48 / $53.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $112.20 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $53.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $63.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $42.66 / $64.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $63.10