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Nebraska 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
$62.47 / $91.47 / $140.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $63.68 / $140.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.82 / $65.64 / $69.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.78 / $75.84 / $78.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.58 / $63.68 / $73.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.47 / $106.42 / $287.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.48 / $63.68 / $71.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.04 / $85.16 / $115.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.76 / $68.62 / $117.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $71.31 / $72.59