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Pennsylvania rates for HCPCS J1096

Dexamethasone Lacrimal Ophthalmic Insert 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.50 / $237.49 / $308.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.50 / $103.96 / $122.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.92 / $111.67 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.82 / $106.82 / $106.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.11 / $102.94 / $102.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $102.94 / $102.94
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.50 / $237.49 / $308.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.50 / $103.96 / $308.52
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.11 / $102.94 / $102.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $102.94 / $102.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.93 / $102.93 / $102.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.94 / $102.94 / $163.19