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Montana rates for HCPCS J1568

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $48.00 / $58.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.79 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.85 / $54.85 / $115.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $54.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.85 / $54.85 / $115.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $51.55 / $67.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $47.53