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Pennsylvania rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.76 / $1,182.89 / $1,536.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $513.85 / $1,063.08
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.16 / $551.95 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.96 / $527.96 / $551.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.96 / $508.76 / $508.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.56 / $862.85 / $1,536.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $513.85 / $1,536.75
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.96 / $508.76 / $508.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.80 / $432.80 / $502.21
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.80 / $432.80 / $502.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $702.60