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Indiana rates for HCPCS J2503

Pegaptanib Sodium Injection

Insurance Carrier
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.41 / $784.55 / $1,338.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.93 / $815.93 / $815.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.50 / $785.50 / $785.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $1,112.01