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New Hampshire rates for HCPCS J1162

Injection, digoxin immune fab (ovine), per vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,968.58 / $5,564.81 / $9,937.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,160.01 / $9,302.81 / $23,445.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,968.58 / $5,168.22 / $5,168.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,875.68 / $5,168.22 / $5,168.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,422.51 / $8,393.20 / $15,951.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,215.66 / $4,637.22 / $5,901.92