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New Hampshire rates for HCPCS J3355

Injection Urofollitropin 75 Iu

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.65 / $127.65 / $157.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.65 / $127.65 / $127.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $63.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.97 / $125.15 / $125.15
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.65 / $140.41 / $178.71