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Indiana 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
$45.77 / $119.26 / $331.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.77 / $45.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $90.62 / $120.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.51 / $45.31 / $64.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $45.31 / $61.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $52.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $45.31 / $120.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $136.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $50.75 / $77.03