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Pennsylvania rates for HCPCS J1322

Injection, elosulfase alfa, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.68 / $717.91 / $932.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $311.77 / $645.04
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.66 / $334.89 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.33 / $320.33 / $334.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.20 / $308.68 / $308.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $308.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.86 / $610.53 / $932.67
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $311.77 / $932.67
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.20 / $308.68 / $308.68
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $308.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.72 / $262.72 / $304.86
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.72 / $262.72 / $304.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.68 / $308.68 / $426.29