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Pennsylvania rates for HCPCS J1580

Injection, garamycin, gentamicin, up to 80 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.03 / $12.53 / $82.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $3.90 / $11.83
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.68 / $646.28 / $1,383.73
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.40 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.21 / $2.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.00 / $8.65 / $39.63
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.68 / $818.79 / $1,383.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.14 / $15.35 / $75.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $3.99 / $11.83
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.21 / $2.21
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $2.79 / $3.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $2.79 / $3.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $4.04