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New Hampshire rates for HCPCS J1645

Injection Dalteparin Sodium Per 2500 Iu (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.04 / $20.20 / $36.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $18.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.77 / $24.81 / $68.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $18.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.60 / $16.54 / $16.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.45 / $27.54 / $51.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.54 / $16.54 / $16.54
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $31.37 / $39.93