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New Hampshire rates for HCPCS J1442

Injection Filgrastim (G-Csf) Excludes Bio- Similiars 1 Microgram (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $1.11 / $1.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.19 / $1.80 / $4.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.00 / $1.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.62 / $3.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.06
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.34 / $1.88