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New Hampshire rates for HCPCS J1428

Injection, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.19 / $163.19 / $200.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.78 / $288.00 / $759.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $163.19 / $163.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.23 / $265.04 / $503.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $160.00
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $179.52 / $228.48