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Pennsylvania rates for HCPCS J1260

Injection Dolasetron Mesylate 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.98 / $8.97 / $14.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $5.98
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.96 / $5.84 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.84 / $5.84 / $5.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.98 / $9.21 / $14.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $11.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $12.93 / $17.82