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Pennsylvania rates for HCPCS J3105

Injection Terbutaline Sulfate Up To 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.77 / $6.93 / $33.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $7.39 / $7.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.82 / $8.02 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.67 / $7.67 / $7.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $7.39 / $7.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.40 / $10.39 / $61.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.77 / $6.73 / $34.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.77 / $7.39 / $8.33
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.97 / $7.39 / $7.39
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $13.52