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Indiana rates for HCPCS J1428

Injection, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.60 / $384.00 / $691.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $153.60 / $153.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.35 / $320.00 / $404.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $192.00 / $259.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.80 / $226.80 / $277.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.80 / $226.80 / $283.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.19 / $163.19 / $432.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $448.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $200.08