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Pennsylvania rates for HCPCS J0400

Injection, aripiprazole, intramuscular, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.63 / $0.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.73
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.79 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.47 / $0.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.73
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $1.19