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Pennsylvania rates for HCPCS J7612

Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.74 / $45.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.28 / $0.39
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.30 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.27 / $2.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $2.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $2.14 / $2.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.73 / $15.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.31 / $0.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.27 / $2.18
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $2.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.27 / $0.49