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South Carolina 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
$2,515.19 / $2,738.56 / $10,799.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,585.41 / $2,608.16 / $2,738.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,663.77 / $2,883.68 / $5,313.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $3,260.20 / $3,936.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,460.53 / $2,608.16 / $3,279.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,887.32
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,343.80 / $2,571.37 / $4,214.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.00 / $2,022.00 / $3,385.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,671.08 / $2,807.10 / $6,520.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.43 / $2,673.43 / $4,411.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,216.94 / $2,764.65 / $3,140.22