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Pennsylvania rates for HCPCS J9395

Injection, fulvestrant, 25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.05 / $322.92 / $759.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.80 / $138.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.90 / $6.90 / $6.90
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.23 / $7.30 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.98 / $6.98 / $6.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.35 / $6.73 / $6.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $7.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.98 / $6.98 / $9.42
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $17.14 / $23.62
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.54 / $7.58 / $8.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.05 / $200.38 / $759.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $7.05 / $148.06
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.40 / $35.20 / $171.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.35 / $6.73 / $6.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $7.62
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.66 / $12.66 / $14.69
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.66 / $12.66 / $14.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $7.13 / $12.32