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Pennsylvania rates for HCPCS J2250

Injection Midazolam Hydrochloride Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $2.94 / $57.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.25 / $1.92
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.17 / $739.54 / $1,007.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $0.17 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $2.52 / $11.28
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.17 / $739.54 / $1,007.38
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $3.95 / $70.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.34 / $4.83
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,984.28 / $5,118.91 / $6,254.98
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.27