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Washington rates for HCPCS J2503

Injection, pegaptanib sodium, 0.3 mg

Insurance Carrier
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.50 / $2,498.51 / $4,966.62
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,422.80 / $1,671.79 / $2,312.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.25 / $889.25 / $889.25