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Pennsylvania rates for HCPCS 80204

Drug Assay Methotrexate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.24 / $104.88 / $161.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.38 / $22.29 / $32.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.22 / $172.99 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.08 / $30.08 / $30.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.35 / $50.11 / $112.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.21 / $43.61 / $57.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.73 / $22.76 / $52.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.94 / $89.62 / $374.57
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.50 / $18.32 / $25.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.78 / $104.88 / $161.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.38 / $30.08 / $159.29
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.07 / $51.36 / $128.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.23 / $43.61 / $55.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.57 / $38.57 / $42.43
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.94 / $38.57 / $42.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.20 / $23.14 / $65.56