go back

Oklahoma rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $16.22 / $27.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $17.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.13 / $15.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $16.22 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.59 / $14.79 / $16.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $15.14 / $15.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $15.14 / $16.98