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Pennsylvania rates for HCPCS J0278

Amikacin Sulfate Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $1.45 / $1.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.64 / $3.41
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.69 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.63 / $0.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.62 / $1.45 / $1.97
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.64 / $1.88
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.63 / $0.63
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $0.86 / $1.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $1.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $1.09