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Illinois rates for HCPCS J9295

Injection Necitumumab 1 Mg (Reinstated 01/01/2017). Polyestradiol Phosphate 40 Mg (Del 03/31/2003).

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.73 / $6.81 / $11.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $6.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.46 / $30.94 / $106.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.73 / $5.73 / $5.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.73 / $6.49
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $10.37 / $19.68
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.45 / $7.45 / $7.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $8.02 / $8.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.73 / $5.96 / $6.51