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Michigan 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
$46.67 / $58.80 / $9,798.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $46.67 / $7,082.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.63 / $98.81 / $188.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.85 / $46.16 / $46.16
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.03 / $62.03 / $62.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.89 / $45.31 / $47.97
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $86.15 / $7,464.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $46.67 / $59.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.89 / $52.10 / $54.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $50.75 / $54.37