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Vermont rates for HCPCS J1572

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $90.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $54.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $54.00 / $59.29