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New Hampshire rates for HCPCS J2779

Injection, ranibizumab, via intravitreal implant (Susvimo), 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $85.11 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $83.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $199.53 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $125.89 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $117.49