go back

Idaho 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 / $2,543.89 / $2,925.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,686.40 / $3,260.20
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 / $2,608.16
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,810.83 / $2,634.24 / $3,812.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,764.65 / $3,260.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.96 / $2,459.28 / $5,213.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,537.07 / $3,700.98 / $6,342.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,129.79 / $3,129.79 / $3,260.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,764.65