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New Hampshire rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.64 / $8.64 / $17.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.31 / $2.72 / $3.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.46 / $12.46 / $29.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.22 / $38.26 / $76.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.58 / $15.12 / $20.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.64 / $19.97 / $29.35