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Pennsylvania rates for HCPCS 80195

Sirolimus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.66 / $47.37 / $99.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $11.89 / $13.18
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.22 / $89.88 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $10.71 / $10.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.02 / $18.27 / $45.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.53 / $15.69 / $24.12
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.32 / $10.61 / $18.59
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.57 / $35.81 / $113.71
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.24 / $13.00 / $13.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.67 / $38.97 / $146.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.30 / $11.98 / $56.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.19 / $20.86 / $45.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.53 / $15.69 / $24.12
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.73 / $13.73 / $13.73
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.08 / $13.73 / $17.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.36 / $16.48 / $16.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.18 / $9.02 / $29.71