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Pennsylvania rates for HCPCS J9017

Injection, arsenic trioxide, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $13.71 / $17.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.52 / $8.15 / $9.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.56 / $8.85 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.46 / $8.46 / $8.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.69 / $8.15 / $8.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.46 / $8.85 / $11.41
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $10.00 / $17.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $8.15 / $14.42
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.70 / $28.80 / $87.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.69 / $8.15 / $8.15
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.46
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.91 / $15.91 / $18.46
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.91 / $15.91 / $18.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.64 / $14.91