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Pennsylvania rates for HCPCS J3410

Injection Hydroxyzine Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.15 / $28.90 / $51.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $15.45 / $21.72
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.11 / $16.60 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.87 / $15.87 / $15.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.43 / $15.30 / $15.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.40 / $84.45 / $108.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.30 / $26.07 / $51.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $17.10 / $51.47
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.43 / $15.30 / $15.30
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $15.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.68 / $10.68 / $12.39
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.68 / $10.68 / $12.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $15.30 / $28.00