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North Dakota 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 / $4,579.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,083.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,829.60 / $2,843.75 / $2,880.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,413.58 / $2,843.75 / $2,880.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,723.89 / $3,459.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,968.61 / $2,569.33 / $4,694.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.89 / $2,874.60 / $12,064.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,251.84