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Pennsylvania rates for HCPCS J1956

Injection, levofloxacin, 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.45 / $7.09 / $168.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $2.54 / $2.92
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.32 / $1,728.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.75 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.54 / $2.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.91 / $16.89 / $126.99
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.28 / $1,659.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $7.00 / $118.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $2.56 / $5.96
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $2.54 / $2.54
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $2.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.97 / $0.97 / $1.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $0.97 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.54 / $2.54 / $4.25