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Utah rates for HCPCS J1573

Injection Hepatitis B Immune Globulin (Hepagam B) Intravenous 0.5ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.30 / $77.30 / $83.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.30 / $77.30 / $77.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.90 / $92.99 / $155.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.70 / $130.58 / $182.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.31 / $66.64 / $74.64