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Pennsylvania rates for HCPCS J1571

Hepagam B Im Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.64 / $167.68 / $217.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $67.31 / $166.11
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.46 / $72.30 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.16 / $69.16 / $69.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.87 / $66.64 / $66.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.00 / $128.00 / $128.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.38 / $142.60 / $217.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $72.38 / $217.85
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.87 / $66.64 / $66.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.43 / $69.43 / $80.56
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.43 / $69.43 / $80.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $74.64 / $95.09