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New Hampshire rates for HCPCS J9021

Injection Asparaginase Recombinant (Rylaze) 0.1 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.30 / $66.36 / $68.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.30 / $55.47 / $57.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.31 / $99.85 / $242.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $55.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.33 / $55.47 / $55.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $55.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $92.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.47 / $55.47 / $58.80
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.78 / $49.26 / $62.69