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New Hampshire rates for HCPCS J1620

Injection Gonadorelin Hydrochloride Per 100 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.72 / $180.72 / $222.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $180.72 / $180.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $180.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.30 / $180.30 / $180.30
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.72 / $198.79 / $253.01