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Utah rates for HCPCS J1595

Injection, glatiramer acetate, 20 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.25 / $62.25 / $62.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.25 / $62.25 / $62.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.75 / $63.75 / $63.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.92 / $337.48 / $484.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.38 / $62.50 / $62.50