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New Hampshire rates for HCPCS J9313

Injection, moxetumomab pasudotox-tdfk, 0.01 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $25.12 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $21.88 / $25.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $61.66 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $22.39 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $22.39 / $22.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.44 / $26.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $23.44 / $23.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.39 / $30.90 / $38.02