go back

New Hampshire rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.91 / $16.70 / $29.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.51 / $25.23 / $64.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.00 / $14.84 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.58 / $24.12 / $45.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $16.63
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.97 / $24.26 / $3,000.00