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Indiana rates for HCPCS Q2017

Injection Teniposide 50 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,396.11 / $5,990.28 / $10,782.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.11 / $2,396.11 / $2,545.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.95 / $2,870.34 / $6,614.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.95 / $346.95 / $558.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.43 / $217.17 / $315.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.43 / $197.43 / $296.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.87 / $2,545.87 / $2,545.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,545.87 / $2,545.87 / $2,545.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,495.94 / $2,645.71 / $2,995.14