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New York rates for HCPCS J1595

Injection, glatiramer acetate, 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $60.00 / $90.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.75 / $60.00 / $63.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.11 / $54.11 / $67.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $62.50 / $62.50
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.50 / $57.50 / $63.25
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $57.50 / $57.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $71.76 / $71.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.95 / $183.95 / $298.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.95 / $183.95 / $211.54
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $183.95
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $65.00 / $183.95
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.75 / $71.76 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $118.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.50 / $62.50 / $116.43
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.95 / $183.95 / $183.95
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $88.08 / $183.95