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Pennsylvania rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.05 / $29.95 / $39.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.95 / $19.94
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.58 / $6.56 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.27 / $6.27 / $6.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $6.05 / $6.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.37 / $31.08 / $92.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.92 / $29.95 / $39.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $9.66 / $38.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $6.05 / $6.05
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.70 / $12.70 / $14.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.70 / $12.70 / $14.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $11.07