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Pennsylvania rates for HCPCS 90296

Diphtheria antitoxin, equine, any route

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.96 / $12.88 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $537.03
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.42 / $31.62 / $91.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $31.62 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13