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Pennsylvania rates for HCPCS J3095

Injection, telavancin, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.11 / $17.48 / $22.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.18 / $13.47
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.56 / $7.72 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.38 / $7.38 / $7.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.71 / $7.11 / $7.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.54 / $12.74 / $22.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.54 / $22.71
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.71 / $7.11 / $7.11
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.98 / $6.98 / $8.10
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.98 / $6.98 / $8.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $10.03