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New Jersey 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 / $3,307.06 / $6,675.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,868.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,460.53 / $2,716.29 / $3,515.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,706.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,706.58 / $2,829.60 / $3,521.02
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.43 / $5,512.61 / $13,785.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,358.92 / $2,543.89 / $2,673.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,078.79 / $2,673.43 / $7,084.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,751.61 / $3,129.79