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New Hampshire rates for HCPCS J0850

Injection, cytomegalovirus immune globulin intravenous (human), per vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,809.44 / $2,026.57 / $3,618.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,809.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.73 / $3,255.57 / $8,204.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,809.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,706.27 / $1,808.65 / $1,808.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,897.64 / $2,937.25 / $5,582.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $2,025.69 / $2,025.69
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,645.53 / $1,810.08 / $2,303.73