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Texas 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 / $9.86 / $12.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.70 / $8.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.03 / $12.73 / $25.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.91 / $5.91 / $5.91
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $8.07 / $8.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.28 / $5.64 / $9.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.64 / $8.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.20 / $5.64 / $9.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.51 / $5.51 / $7.61