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Pennsylvania rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.59 / $318.77 / $414.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $137.59 / $165.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $136.22 / $136.22
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.58 / $148.27 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.82 / $141.82 / $141.82
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 / $141.82
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.82 / $148.27 / $170.96
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.53 / $240.53 / $281.83
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.93 / $146.93 / $146.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.59 / $232.53 / $18,552.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $138.03 / $288.81
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.40 / $210.10 / $255.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $136.66 / $136.66
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $143.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.11 / $118.11 / $137.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.11 / $118.11 / $137.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $144.87 / $176.61