go back

Montana rates for HCPCS J0257

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $14.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $46,773.51 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $14.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $6.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.57 / $5.75 / $16.22
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.57 / $5.75 / $16.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $14.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $8.13 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75