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Pennsylvania rates for HCPCS J1575

Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $36.31 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $25.70
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $19.95 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.62 / $19.05 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $31.62 / $31.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.62 / $33.88 / $56.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $51.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $18.62 / $21.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.90 / $18.62 / $21.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $20.42 / $26.30