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Pennsylvania rates for HCPCS J7170

Injection, emicizumab-kxwh, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $134.38 / $174.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.66 / $69.48
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.73 / $60.86 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.22 / $58.22 / $58.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.93 / $56.10 / $56.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.01 / $134.38 / $174.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $58.01 / $174.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.93 / $56.10 / $56.10
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $49.95 / $57.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.95 / $49.95 / $57.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $77.47