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Massachusetts 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
$2,608.16 / $3,452.06 / $5,022.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,052.67
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,206.44 / $6,530.83 / $13,040.80
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,738.57 / $12,064.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,795.95 / $3,202.82 / $6,223.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,732.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,787.18
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,909.00 / $3,504.00 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,018.68
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,469.35 / $13,040.80 / $13,040.80
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,764.65 / $12,064.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,764.65 / $3,378.38