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Arizona rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.84 / $273.33 / $410.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $142.19 / $187.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.34 / $417.72 / $720.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.47 / $131.19 / $144.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $136.66 / $136.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.22 / $157.34 / $267.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $136.22 / $295.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $144.87