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Louisiana rates for HCPCS J1595

Injection Glatiramer Acetate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $105.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.84 / $50.59 / $221.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.62 / $147.62 / $150.57
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $130.57