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New Hampshire rates for HCPCS J9120

Injection, dactinomycin, 0.5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.92 / $363.50 / $372.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $394.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.53 / $591.01 / $1,435.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $328.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.75 / $328.34 / $328.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $328.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $550.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.34 / $328.34 / $365.51
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.16 / $1,781.58 / $2,732.79