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Michigan rates for HCPCS J9309

Inj, polatuzumab vedotin 1mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.32 / $182.42 / $272.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $140.32 / $164.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.76 / $298.07 / $567.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.28 / $144.81 / $187.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $161.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.66 / $272.45 / $390.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $140.32 / $177.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.72 / $146.00 / $199.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $152.13 / $169.48