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Pennsylvania rates for HCPCS J3101

Injection, tenecteplase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.21 / $443.61 / $19,197.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $173.94 / $338.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.81 / $186.84 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.72 / $178.72 / $178.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.47 / $172.22 / $172.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $172.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.70 / $442.70 / $652.77
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.66 / $421.99 / $12,465.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $173.94 / $522.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.47 / $172.22 / $172.22
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $172.22
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.65 / $143.65 / $166.69
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.65 / $143.65 / $166.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $243.23