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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
$18.14 / $43.03 / $55.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.32 / $37.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.73 / $19.69 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $18.84 / $19.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.12 / $18.14 / $18.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.57 / $31.38 / $55.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.57 / $55.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.12 / $18.14 / $18.14
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.04 / $16.04 / $18.61
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.04 / $16.04 / $18.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $20.32 / $26.32