go back

Tennessee 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 / $7.42 / $12.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.70 / $7.70 / $7.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $6.72