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Vermont 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
$45.31 / $50.34 / $82.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $51.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $51.09 / $85.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $51.09 / $85.15
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $45.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.14 / $50.75 / $89.05