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New Hampshire rates for HCPCS J0278

Injection, amikacin sulfate, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.74 / $1.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $1.29 / $2.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.62 / $0.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $0.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.02 / $1.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.62 / $1.35