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Wisconsin rates for HCPCS J1572

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

Facilitymedian $54 · 10th–90th $50$1820%20%40%10th90th$54Professionalmedian $52 · 10th–90th $50$930%50%10th90th$52$50.0$100.0$200.0

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
$50.12 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $52.48 / $63.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $194.98 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $85.11 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $69.18 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $67.61
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $51.29 / $56.23
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $85.11
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $56.23 / $56.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $66.07
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $58.88 / $72.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $281.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $67.61 / $77.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $66.07