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Wyoming 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
$47.80 / $47.80 / $47.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $45.77 / $45.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.05 / $104.76 / $104.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.75 / $42.75 / $42.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $64.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.31 / $45.31 / $50.75