go back

Pennsylvania rates for HCPCS J3030

Injection Sumatriptan Succinate 6 Mg (Code May Be Used For Medicare When Drug Administered Under The Direct Supervision Of A Physician Not For Use When Drug Is Self Administered) (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.30 / $66.00 / $305.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $37.74 / $156.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.37 / $93.38 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.38 / $93.38 / $93.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.74 / $37.74 / $37.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $37.74 / $37.74
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.12 / $89.00 / $329.56
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.30 / $58.12 / $305.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $38.33 / $148.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.74 / $37.74 / $37.74
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.74 / $37.74 / $37.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $37.00 / $63.77