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Utah 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
$55.13 / $55.13 / $94.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.13 / $55.13 / $55.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.67 / $65.77 / $74.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.53 / $47.53 / $119.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $53.23