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North Dakota rates for HCPCS J1557

Injection, immune globulin, (Gammaplex), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $63.10 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $81.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $69.18 / $70.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $69.18 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $81.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $63.10 / $186.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $69.18 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $70.79 / $70.79