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Arizona rates for HCPCS J9268

Pentostatin Per 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,790.73 / $4,561.20 / $7,824.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,634.24 / $3,357.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,086.53 / $8,192.60 / $14,513.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,462.48 / $2,503.83 / $2,754.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,460.53 / $2,608.16 / $2,732.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,883.95 / $2,798.28 / $4,459.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,543.89 / $12,064.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.43 / $2,673.43 / $4,411.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,764.65