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Maryland 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
$2,460.87 / $2,543.89 / $2,543.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,790.40
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,543.89 / $2,608.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,732.53 / $2,732.53 / $3,010.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,075.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,216.94 / $2,608.16 / $3,187.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,903.43 / $3,135.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,732.53 / $2,732.53 / $3,434.25