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Utah 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
$74.13 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $64.57 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $81.28 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $91.20 / $223.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $67.61 / $67.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $63.10 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $70.79