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Connecticut 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
$2,712.48 / $3,707.35 / $7,048.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,078.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $4,136.02 / $7,945.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,706.58 / $2,829.60 / $3,262.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,483.96 / $2,608.16 / $2,868.98