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Pennsylvania rates for HCPCS J2670

Injection Tolazoline Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.51 / $5.62 / $8.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $3.51 / $3.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.92 / $3.43 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $3.43 / $3.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.51 / $5.41 / $8.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.51 / $3.51 / $6.98
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.44 / $3.44 / $3.44
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.64 / $3.64 / $3.64
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.64 / $3.64 / $3.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.13 / $4.13 / $7.12