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New Hampshire rates for HCPCS J7308

Aminolevulinic acid HCl for topical administration, 20%, single unit dosage form (354 mg)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.87 / $441.13 / $787.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.08 / $392.09 / $431.22
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.33 / $784.18 / $1,778.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.09 / $392.09 / $393.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.90 / $392.09 / $392.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.09 / $392.09 / $392.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.09 / $652.83 / $1,291.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.17 / $392.09 / $407.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.98 / $452.20 / $693.64