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New Hampshire rates for HCPCS 67028

Intravitreal Njx Pharmacologic Agt Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.48 / $712.94 / $2,331.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.55 / $111.70 / $226.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.09 / $1,359.00 / $3,300.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.63 / $136.01 / $199.65
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$132.94 / $206.80 / $295.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.87 / $178.32 / $272.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.08 / $196.74 / $382.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.68 / $225.95 / $350.35
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.83 / $98.58 / $175.22