go back

Pennsylvania rates for HCPCS 96375

Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.04 / $70.44 / $420.00
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.51 / $27.51 / $27.51
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.24 / $15.58 / $31.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $24.03 / $35.61
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.51 / $27.51 / $27.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.27 / $61.56 / $405.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $29.28 / $35.61
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.76 / $14.76 / $46.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.66 / $23.77 / $35.56