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New Hampshire rates for HCPCS 80376

Drug/Substance Definitive Qual/Quant Nos 4-6

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.93 / $8.93 / $16.41
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 / $12.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.09 / $36.33 / $69.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.52 / $15.12 / $47.49
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00