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Montana rates for HCPCS J1557

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $75.59 / $140.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.30 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.61 / $65.61 / $158.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $65.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.61 / $65.61 / $158.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $69.09 / $90.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68