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New Hampshire rates for HCPCS J2407

Injection Oritavancin (Orbactiv) 10 Mg (Desc Rvsd 10/1/21)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.52 / $31.94 / $57.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.18 / $51.62 / $130.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.52 / $28.68 / $28.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.06 / $28.68 / $28.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.09 / $46.58 / $88.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.68 / $28.68 / $28.68
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $29.96 / $3,000.00