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Vermont rates for HCPCS J9309

Inj, polatuzumab vedotin 1mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $234.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.72 / $154.72 / $154.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $150.25 / $250.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $250.42
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.93 / $150.25 / $250.42
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $250.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.38 / $142.13 / $315.76