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Pennsylvania rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.05 / $0.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $19.66 / $19.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.06 / $14.06 / $14.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.29 / $27.16 / $29.94
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.49 / $109.12 / $1,014.32
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.03 / $0.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.29 / $27.16 / $29.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.31 / $9.31 / $9.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.99 / $14.81 / $38.61