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Illinois 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 / $3,155.87 / $5,138.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,608.16 / $2,868.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,950.40 / $6,950.50 / $32,049.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,718.55 / $3,070.19 / $3,070.19
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 / $3,444.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,086.53 / $3,305.43 / $5,290.11
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,390.61 / $3,390.61 / $3,390.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,673.43 / $3,742.80 / $4,010.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.43 / $4,411.16 / $4,411.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,764.65 / $3,103.71