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Pennsylvania 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
$47.53 / $102.57 / $147.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $49.45 / $6,061.83
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.83 / $51.56 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.32 / $49.32 / $51.57
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
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.86 / $82.57 / $147.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $54.65 / $6,061.83
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.83 / $47.52 / $47.52
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.07 / $41.07 / $47.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.07 / $41.07 / $47.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $53.23 / $86.98