go back

Minnesota 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 / $2,608.16 / $2,608.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,078.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.23 / $2,999.37 / $5,309.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,136.87 / $2,590.96 / $2,671.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,283.90 / $4,010.15 / $8,315.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,723.89 / $2,996.28 / $3,459.34
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,104.93 / $3,969.63 / $9,049.49
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,723.89 / $2,723.89 / $2,762.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,854.05 / $2,543.89 / $4,694.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,831.88 / $6,558.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,764.65 / $5,477.14