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Pennsylvania rates for HCPCS J3250

Injection, trimethobenzamide HCl, up to 200 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.94 / $112.59 / $162.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $57.51 / $64.61
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.29 / $602.36 / $1,289.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.26 / $62.39 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.68 / $59.68 / $59.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.25 / $57.51 / $57.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $57.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.68 / $62.39 / $72.75
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.36 / $72.28 / $152.40
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.90 / $60.90 / $60.90
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.29 / $63.79 / $1,238.25
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.94 / $115.27 / $226.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.94 / $57.51 / $96.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.70 / $27.40 / $96.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.25 / $57.51 / $57.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $59.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.04 / $43.04 / $49.94
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.04 / $43.04 / $49.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $73.61