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Virginia 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
$47.58 / $108.41 / $24,357.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $47.58 / $80.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $95.60 / $154.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.65 / $70.16 / $105.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $42.75 / $45.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.51 / $54.37 / $104.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.25 / $67.33 / $75.17
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $45.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.04 / $54.83 / $93.24
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.04 / $54.83 / $93.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $54.37