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Nebraska rates for HCPCS J1572

Injection Immune Globulin (Flebogamma) Intravenous Non-Lyophilized (E.G. Liquid) 500mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $110.81 / $140.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $50.82 / $105.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.66 / $60.35 / $63.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.35 / $62.89 / $63.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $54.00 / $66.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.57 / $55.76 / $278.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $59.29 / $60.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.71 / $66.81 / $109.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.78 / $49.88 / $73.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.94 / $56.33 / $59.29