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Montana rates for HCPCS J1569

Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $49.39 / $8,018.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.17 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.51 / $51.51 / $124.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $51.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.51 / $51.51 / $124.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $49.16 / $64.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31