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Missouri 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 / $104.76 / $7,070.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $46.22 / $75.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $49.39 / $162.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $56.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $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 / $69.50 / $225.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.26 / $47.80 / $55.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $81.23