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Pennsylvania rates for HCPCS J1212

Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.31 / $1,268.04 / $2,258.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $750.32 / $1,043.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.57 / $812.43 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.10 / $777.10 / $777.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.46 / $748.84 / $748.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.84 / $748.84 / $748.84
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$157.31 / $598.97 / $831.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.85 / $1,268.04 / $2,258.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.74 / $756.33 / $2,258.42
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.46 / $748.84 / $748.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.84 / $748.84 / $748.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.71 / $637.71 / $739.98
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.71 / $637.71 / $739.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.84 / $748.84 / $748.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.85 / $748.85 / $1,057.63