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New Hampshire rates for HCPCS J9268

Pentostatin Per 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,543.89 / $3,052.67 / $3,130.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,585.41 / $2,608.16 / $2,712.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,118.06 / $4,694.68 / $11,399.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,460.53 / $2,608.16 / $2,608.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,608.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $4,370.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.16 / $2,608.16 / $2,847.59
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,487.85 / $2,736.64 / $3,482.99