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Montana rates for HCPCS J1561

Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,447.16 / $16,447.16 / $16,447.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.96 / $53.37 / $110.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.42 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.19 / $55.19 / $123.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.96 / $48.96 / $55.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.19 / $55.19 / $123.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.96 / $53.12 / $69.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.96 / $48.96 / $48.96