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Pennsylvania rates for HCPCS C9091

Sirolimus, Protein-Bound,1mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.20 / $69.20 / $87.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.20 / $69.20 / $69.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.20 / $69.20 / $87.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.14 / $69.20 / $69.20