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Pennsylvania rates for HCPCS Q0138

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $613.22 / $1,204.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $204.00 / $1,144.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.35 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.32 / $0.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.68 / $1.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $418.83 / $1,378.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.95 / $1,144.95
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.32 / $0.32
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.65
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.59