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Washington rates for HCPCS J2997

Injection, alteplase recombinant, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $194.98 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $100.00 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $114.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $114.82 / $177.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $104.71 / $251.19
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $100.00 / $107.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $109.65 / $263.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $123.03