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West 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
$42.57 / $42.57 / $54.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.73 / $54.00 / $54.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.82 / $32.82 / $84.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $80.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $52.94 / $63.53