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New Hampshire rates for HCPCS J1212

Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.90 / $832.05 / $1,485.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.85 / $748.85 / $748.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.55 / $1,347.93 / $3,397.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.90 / $748.85 / $748.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.46 / $748.84 / $748.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.84 / $748.84 / $748.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.69 / $1,216.13 / $2,311.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.85 / $748.85 / $1,085.83
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.56 / $725.60 / $1,113.01