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Pennsylvania rates for HCPCS J2995

Injection Streptokinase Per 250 000 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.69 / $122.72 / $197.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.69 / $79.69 / $79.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.14 / $77.81 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.81 / $77.81 / $77.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.50 / $79.50 / $79.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.50 / $79.50 / $79.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.69 / $119.54 / $197.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.69 / $79.69 / $158.58
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.50 / $79.50 / $79.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.50 / $79.50 / $79.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.42 / $117.42 / $117.42
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.42 / $117.42 / $117.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.69 / $90.69 / $125.24