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Pennsylvania rates for HCPCS J0121

Injection Omadacycline 1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $9.38 / $12.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.05 / $8.25
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.71 / $4.36 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.79 / $4.09 / $4.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.09
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $9.38 / $12.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.18 / $12.19
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.79 / $4.09 / $4.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.09 / $4.09 / $4.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.68 / $3.68 / $4.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.68 / $3.68 / $4.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.01 / $4.01 / $5.68