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Pennsylvania rates for HCPCS J2407

Injection Oritavancin (Orbactiv) 10 Mg (Desc Rvsd 10/1/21)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.68 / $66.73 / $86.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.97 / $62.36
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.45 / $31.12 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.76 / $29.76 / $29.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.06 / $28.68 / $28.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.81 / $56.75 / $86.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.97 / $86.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.06 / $28.68 / $28.68
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.01 / $26.01 / $30.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.01 / $26.01 / $30.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $40.51