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Alaska rates for HCPCS J1569

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.35 / $311.14 / $17,387.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $50.34 / $111.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.52 / $120.52 / $120.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $145.90
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.13 / $142.38 / $223.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.03 / $142.38 / $335.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $49.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.75 / $67.97 / $135.93