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Arizona 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
$48.48 / $90.62 / $8,307.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $57.84 / $8,018.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.32 / $156.63 / $257.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.81 / $46.27 / $306.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.23 / $45.31 / $45.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.80 / $75.19 / $90.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.80 / $47.80 / $52.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31