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New Hampshire 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 / $54.19 / $18,259.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $48.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.05 / $78.47 / $207.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $48.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.83 / $47.52 / $47.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.87 / $77.19 / $146.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $53.23
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.08 / $39.69 / $50.51