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Idaho rates for HCPCS J1557

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.47 / $62.47 / $71.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $70.05 / $79.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.08 / $63.68 / $63.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.05 / $84.38 / $113.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $79.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.68 / $63.68 / $89.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.29 / $76.42 / $76.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $89.15