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New Hampshire rates for HCPCS J7503

Tacrolimus, extended release, (Envarsus XR), oral, 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $2.20 / $2.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.19 / $2.75 / $3.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.83 / $1.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $3.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83