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Pennsylvania rates for HCPCS J1885

Injection Ketorolac Tromethamine Per 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $6.00 / $69.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $2.06 / $5.53
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.43 / $382.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.33 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.78 / $20.75
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.42 / $382.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.19 / $6.20 / $74.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $1.96 / $6.16
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.30 / $0.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.69
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.55