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New Hampshire rates for HCPCS J9210

Injection Emapalumab-Lzsg 1 Mg (Reinstated) Hexamethylmelamine (Deleted 3/31/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.64 / $427.44 / $763.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.70 / $692.73 / $1,745.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.64 / $384.85 / $384.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.06 / $384.85 / $384.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.78 / $625.00 / $1,187.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $407.94
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.45 / $378.90 / $482.23