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Iowa 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
$3,541.54 / $3,541.54 / $5,596.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $5,397.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,723.89 / $3,805.60
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,160.34 / $2,676.96 / $5,666.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,432.91 / $2,901.12 / $4,299.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,831.88 / $12,064.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,352.08 / $3,750.70 / $4,781.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,745.00 / $3,208.12 / $4,202.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,537.10 / $5,164.41 / $5,448.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.16 / $4,411.16 / $4,411.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,686.40 / $3,338.44
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.88 / $2,783.88 / $2,783.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,199.27 / $2,783.88 / $2,783.88