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New Mexico 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
$45.31 / $74.52 / $74.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.77 / $113.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.81 / $214.85 / $351.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.50 / $46.50 / $62.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.93 / $39.93 / $39.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.09 / $45.31 / $47.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31