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Pennsylvania rates for HCPCS J0791

Injection, crizanlizumab-tmca, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.77 / $303.22 / $393.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $130.77 / $320.70
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.40 / $140.47 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.37 / $134.37 / $140.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.15 / $129.47 / $129.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $129.47
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.81 / $361.81 / $361.81
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.87 / $303.22 / $393.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $141.65 / $393.92
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.15 / $129.47 / $129.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $129.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.13 / $125.13 / $145.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.13 / $125.13 / $145.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.47 / $129.47 / $168.97