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Washington 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
$49.85 / $99.42 / $13,866.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $49.85 / $4,338.45
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $54.79 / $106.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.84 / $50.40 / $101.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $42.75 / $112.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $55.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.31 / $56.64 / $99.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.74 / $73.29 / $123.63
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.58 / $50.40 / $101.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.07 / $49.84 / $90.14
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.84 / $49.84 / $49.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $50.75