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Utah 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
$91.40 / $91.40 / $1,692.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.40 / $91.40 / $91.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.26 / $114.79 / $123.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $78.79 / $78.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.80 / $78.80 / $209.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.86 / $78.80 / $88.26