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Louisiana rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.22 / $175.74 / $405.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $137.59 / $164.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $136.22 / $136.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.48 / $95.60 / $134.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.32 / $134.32 / $137.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,812.45 / $11,812.45 / $11,812.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $128.93 / $136.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.00 / $136.66 / $157.31