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Washington rates for HCPCS J1568

Octagam Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.72 / $90.51 / $100.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $52.28 / $5,153.75
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.53 / $57.36 / $108.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.28 / $53.49 / $116.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.83 / $44.83 / $119.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $58.29
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.52 / $59.41 / $100.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.47 / $74.66 / $125.94
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.37 / $56.74 / $116.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.12 / $52.28 / $95.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.28 / $52.28 / $52.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $53.23