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Maryland 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
$47.80 / $743.98 / $7,293.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $57.92
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.32 / $45.32 / $47.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $57.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $94.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $52.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.46 / $46.46 / $46.46