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Pennsylvania rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.56 / $0.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.67 / $0.79 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.59 / $0.99
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.05 / $1.45