go back

West Virginia rates for HCPCS J0257

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $5.77 / $6.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $5.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.64 / $8.46 / $8.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.64 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $10.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.64 / $5.64 / $7.90