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Louisiana rates for HCPCS J1428

Injection, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.00 / $192.00 / $268.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.00 / $192.00 / $192.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.03 / $167.58 / $192.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.80 / $172.80 / $176.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.19 / $163.19 / $192.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $192.00