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Pennsylvania rates for HCPCS J0122

Inj., eravacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $3.02 / $3.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.32 / $2.67
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.41 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.33 / $1.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.30 / $2.57 / $3.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.32 / $3.92
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.33 / $1.33
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.22
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.29 / $1.29 / $1.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.80