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Missouri 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 / $3,541.54 / $4,816.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,660.32 / $3,541.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.16 / $2,790.73 / $9,368.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,312.36
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 / $3,321.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.89 / $3,052.67 / $4,670.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,416.69 / $2,696.52 / $12,064.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.58 / $3,579.72 / $4,793.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,529.92 / $2,608.16 / $3,103.71