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Idaho rates for HCPCS J1595

Injection Glatiramer Acetate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $63.75 / $64.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.31 / $64.50 / $92.24
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.47 / $60.47 / $1,621.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.42 / $250.61 / $417.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.95 / $183.95 / $229.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $87.50