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New Hampshire rates for HCPCS J0570

Buprenorphine Implant 74.2 Mg (Special Coverage Instructions Apply. See Mcm: 2049) (Reinstated 01/01/2017). Injection Penicillin G Benzathine Up To 1 200 000 Units (Special Coverage Instructions Apply. See Mcm: 2049) (Del 12/31/2010)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.25 / $1,262.25 / $1,262.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,360.81 / $4,106.30 / $5,950.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.50 / $1,237.50 / $1,237.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.52 / $1,408.57 / $1,792.73