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Utah 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
$3,025.46 / $3,025.46 / $3,025.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,634.24 / $3,260.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,196.55 / $3,609.00 / $4,150.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,825.71 / $2,673.43 / $3,434.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,704.12 / $5,124.88 / $7,357.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,868.98 / $3,535.15 / $3,721.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16