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New Hampshire rates for HCPCS J9017

Injection, arsenic trioxide, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.86 / $7.03 / $7.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.10 / $8.15 / $9.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.74 / $14.67 / $35.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.69 / $8.15 / $8.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $8.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $13.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.15 / $8.15 / $9.07
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.81 / $53.51 / $80.81