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Pennsylvania 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 / $9.75 / $17.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.70 / $12.65
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.20 / $6.12 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.85 / $5.85 / $5.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.64 / $5.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $6.97 / $6.97
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $8.78 / $17.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.77 / $17.36
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.64 / $5.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.92
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $7.90