go back

Louisiana 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 / $3,281.62 / $7,168.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,129.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,119.84 / $2,821.64 / $4,411.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,793.73 / $2,940.77 / $2,999.59
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.58 / $3,261.58 / $3,261.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,347.34 / $2,608.16 / $3,181.96