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Oklahoma 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
$2,671.08 / $2,747.41 / $3,873.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,660.32 / $3,129.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.75 / $1,354.69 / $2,148.00
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 / $2,608.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,968.61 / $2,747.41 / $3,846.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,335.71 / $2,673.43 / $12,064.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,411.16 / $4,411.16 / $4,411.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $3,103.71