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Montana rates for HCPCS J1566

Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,088.80 / $21,088.80 / $21,088.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.89 / $87.53 / $178.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.31 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.48 / $92.48 / $197.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $78.79 / $92.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.48 / $92.48 / $197.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $85.48 / $111.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.80 / $78.80 / $78.80