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Montana rates for HCPCS J9268

Pentostatin Per 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,842.89 / $3,260.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,381.20 / $68,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,278.73 / $3,278.73 / $6,116.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,278.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,854.05 / $2,619.36 / $3,442.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $3,177.21 / $3,415.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16