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New Hampshire rates for HCPCS J1260

Injection Dolasetron Mesylate 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.98 / $5.98 / $7.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $5.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $5.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $10.27 / $19.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.20 / $12.20 / $12.93
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $6.58 / $8.36