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New Hampshire rates for HCPCS J1110

Injection, dihydroergotamine mesylate, per 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.07 / $108.72 / $194.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $97.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.73 / $90.00 / $246.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $97.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.61 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.43 / $99.90 / $185.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.70 / $122.58 / $188.02