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Montana rates for HCPCS J1459

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,386.00 / $12,386.00 / $21,317.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.24 / $61.02 / $8,326.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.44 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.14 / $56.14 / $121.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $56.14
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.14 / $56.14 / $121.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $55.05 / $71.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74