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Nebraska rates for HCPCS J1568

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.38 / $84.67 / $105.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $108.02 / $7,607.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.67 / $48.98 / $51.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.38 / $57.71 / $59.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $48.98 / $61.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.38 / $84.99 / $240.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $48.38 / $55.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.25 / $73.95 / $98.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.96 / $57.67 / $97.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $53.23 / $53.23