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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
$5.75 / $11.22 / $17.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $7.94
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $6.17 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $5.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.51 / $9.77 / $9.77
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.92 / $6.92 / $6.92
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $10.47 / $17.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.13 / $15.85
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $5.89 / $10.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $5.13 / $8.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $7.94