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New Hampshire rates for HCPCS J0841

Injection, crotalidae immune F(ab')2 (equine), 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,044.14 / $1,169.44 / $2,088.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,245.71 / $1,881.27 / $4,741.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.14 / $1,045.15 / $1,045.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.99 / $1,045.15 / $1,045.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.57 / $1,697.32 / $3,225.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.40 / $1,368.84 / $1,742.16