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New Hampshire rates for HCPCS J0558

Injection, penicillin G benzathine and penicillin G procaine, 100,000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.37 / $19.45 / $34.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.45 / $19.52 / $19.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.27 / $35.14 / $88.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.37 / $19.52 / $19.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.42 / $19.52 / $19.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.48 / $31.70 / $60.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.40 / $4.08 / $6.44