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IVIG & SCIG Immune Globulin Intravenous & Subcutaneous

Immune globulin (IG) is made from pooled plasma collected from thousands of donors. Immune globulin contains antibodies against a broad spectrum of bacteria and viruses, and is used primarily to treat three categories of illnesses: primary immune deficiencies, autoimmune neuromuscular disorders, and certain rheumatologic conditions. Immune globulin therapy may be administered intravenously (IVIG) or subcutaneously (SCIG).

Intravenous Immune Globulin (IVIG)

Calculate Your Medicare IVIG Reimbursement Rate

PRODUCT SIZE MFGR NDC # CODE* PRICE
IMMUNE GLOBULIN (HUMAN) LYOPHILIZED
CARIMUNE NF 6 GM VIAL CSL BEHRING 44206-0417-06 J1566 $58.00 /GM
12 GM VIAL 44206-0418-12 J1566 $58.00 /GM
GAMMAGARD S/D (IGA<1 MCG/ML) 5 GM VIAL BAXTER 00944-2655-03 J1566 $107.62 /GM
10 GM VIAL 00944-2655-04 J1566 $107.62 /GM
IMMUNE GLOBULIN (HUMAN) LIQUID
FLEBOGAMMA 5% DIF 2.5 GM VIAL GRIFOLS 61953-0004-02 J1572 $75.00 /GM
5 GM VIAL 61953-0004-03 J1572 $75.00 /GM
10 GM VIAL 61953-0004-04 J1572 $75.00 /GM
20 GM VIAL 61953-0004-05 J1572 $75.00 /GM
FLEBOGAMMA 10% DIF 5 GM VIAL GRIFOLS 61953-0005-01 J1572 $75.00 /GM
10 GM VIAL 61953-0005-02 J1572 $75.00 /GM
20 GM VIAL 61953-0005-03 J1572 $75.00 /GM
GAMASTAN S/D 2 ML VIAL GRIFOLS 13533-0635-04 J1460 $61.88 /VL
10 ML VIAL 13533-0635-12 J1460 $286.84 /VL
GAMMAGARD LIQUID 1 GM VIAL BAXTER 00944-2700-02 J1569 $80.01 /GM
2.5 GM VIAL 00944-2700-03 J1569 $80.01 /GM
5 GM VIAL 00944-2700-04 J1569 $80.01 /GM
10 GM VIAL 00944-2700-05 J1569 $80.01 /GM
20 GM VIAL 00944-2700-06 J1569 $80.01 /GM
30 GM VIAL 00944-2700-07 J1569 $80.01 /GM
GAMMAKED 1 GM VIAL KEDRION 76125-0900-01 J1561 $79.00 /GM
2.5 GM VIAL 76125-0900-25 J1561 $79.00 /GM
5 GM VIAL 76125-0900-50 J1561 $79.00 /GM
10 GM VIAL 76125-0900-10 J1561 $79.00 /GM
20 GM VIAL 76125-0900-20 J1561 $79.00 /GM
GAMMAPLEX 5 GM VIAL BPL 64208-8234-02 J1557 $71.80 /GM
10 GM VIAL 64208-8234-03 J1557 $71.80 /GM
GAMUNEX-C 1 GM VIAL GRIFOLS 13533-0800-12 J1561 $79.00 /GM
2.5 GM VIAL 13533-0800-15 J1561 $79.00 /GM
5 GM VIAL 13533-0800-20 J1561 $79.00 /GM
10 GM VIAL 13533-0800-71 J1561 $79.00 /GM
20 GM VIAL 13533-0800-24 J1561 $79.00 /GM
HIZENTRA 1 GM VIAL CSL BEHRING 44206-0451-01 J1559 $81.61 /VL
2 GM VIAL 44206-0451-02 J1559 $163.22 /VL
4 GM VIAL 44206-0451-04 J1559 $326.44 /VL
10 GM VIAL 44206-0451-10 J1559 $816.10 /VL
OCTAGAM 2.5 GM VIAL OCTAPHARMA 67467-0843-02 J1568 $79.00 /GM
2.5 GM VIAL 68209-0843-02 J1568 $79.00 /GM
5 GM VIAL 67467-0843-03 J1568 $79.00 /GM
5 GM VIAL 68209-0843-03 J1568 $79.00 /GM
10 GM VIAL 67467-0843-04 J1568 $79.00 /GM
10 GM VIAL 68209-0843-04 J1568 $79.00 /GM
OCTAGAM 10% 20 ML OCTAPHARMA 68982-0850-01 TBD TBD
50 ML 68982-0850-02 TBD TBD
100 ML 68982-0850-03 TBD TBD
200 ML 68982-0850-04 TBD TBD
PRIVIGEN 5 GM VIAL CSL BEHRING 44206-0436-05 J1459 $77.30 /GM
10 GM VIAL 44206-0437-10 J1459 $77.30 /GM
20 GM VIAL 44206-0438-20 J1459 $77.30 /GM
40 GM VIAL 44206-0439-40 J1459 $77.30 /GM
*All codes should be verified between the provider and the payer.

 
 

Subcutaneous Immune Globulin (SCIG)


PRODUCT SIZE MFGR NDC # CODE* PRICE
SUBCUTANEOUS IMMUNE GLOBULIN (SCIG)
HIZENTRA 1 GM VIAL CSL BEHRING 44206-0451-01 J1559 $81.61 /VL
2 GM VIAL 44206-0451-02 J1559 $163.22 /VL
4 GM VIAL 44206-0451-04 J1559 $326.44 /VL
10 GM VIAL 44206-0451-10 J1559 $816.10 /VL
GAMUNEX-C 1 GM VIAL GRIFOLS 13533-0800-12 J1561 $79.00 /GM
2.5 GM VIAL 13533-0800-15 J1561 $79.00 /GM
5 GM VIAL 13533-0800-20 J1561 $79.00 /GM
10 GM VIAL 13533-0800-71 J1561 $79.00 /GM
20 GM VIAL 13533-0800-24 J1561 $79.00 /GM
GAMMAGARD LIQUID 1 GM VIAL BAXTER 00944-2700-02 J1569 $80.01 /GM
2.5 GM VIAL 00944-2700-03 J1569 $80.01 /GM
5 GM VIAL 00944-2700-04 J1569 $80.01 /GM
10 GM VIAL 00944-2700-05 J1569 $80.01 /GM
20 GM VIAL 00944-2700-06 J1569 $80.01 /GM
30 GM VIAL 00944-2700-07 J1569 $80.01 /GM
GAMMAKED 1 GM VIAL KEDRION 76125-0900-01 J1561 $79.00 /GM
2.5 GM VIAL 76125-0900-25 J1561 $79.00 /GM
5 GM VIAL 76125-0900-50 J1561 $79.00 /GM
10 GM VIAL 76125-0900-10 J1561 $79.00 /GM
20 GM VIAL 76125-0900-20 J1561 $79.00 /GM
*All codes should be verified between the provider and the payer.

 
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