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Pennsylvania rates for HCPCS J3355

Injection, urofollitropin, 75 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.65 / $191.48 / $316.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.65 / $127.65 / $127.65
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.95 / $124.65 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.65 / $124.65 / $124.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.65 / $196.58 / $316.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.65 / $127.65 / $254.02
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.15 / $125.15 / $172.83