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Georgia 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
$2,543.89 / $2,608.16 / $5,366.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,608.16 / $3,078.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $4,173.06 / $9,571.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,660.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $5,111.99
CareSource
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
$2,460.53 / $2,460.53 / $2,608.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,321.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,109.35 / $2,732.53 / $4,617.37
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,077.50 / $3,501.19 / $5,233.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.43 / $5,213.18 / $5,213.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,750.30 / $3,338.44