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Louisiana rates for HCPCS J0257

Injection, alpha 1 proteinase inhibitor (human), (GLASSIA), 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $5.88 / $12.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.70 / $6.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.73 / $4.48 / $6.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $6.00 / $6.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.32 / $5.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.53 / $5.64 / $7.90