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Nebraska rates for HCPCS J1569

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.80 / $83.65 / $19,981.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $4,544.22 / $9,875.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.86 / $47.85 / $49.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.78 / $55.57 / $58.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.98 / $57.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.80 / $90.82 / $225.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.13 / $47.80 / $54.49
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.44 / $69.69 / $92.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.62 / $55.59 / $101.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $50.75 / $51.65