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Maine 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
$6,050.93 / $6,050.93 / $6,520.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,712.48 / $3,078.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,319.69 / $2,899.49 / $8,265.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,706.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,010.31
Cigna
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 / $2,608.16
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,050.93 / $6,050.93 / $6,520.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,738.56 / $4,273.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,781.83