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South Carolina rates for HCPCS J9309

Inj, polatuzumab vedotin 1mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.50 / $11,346.03 / $11,346.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.11 / $138.03 / $164.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.84 / $131.29 / $217.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $151.55 / $184.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $136.66 / $159.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $141.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.64 / $136.66 / $220.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.64 / $102.64 / $198.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.69 / $138.45 / $321.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.17 / $144.87 / $157.16