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New Hampshire rates for HCPCS J1571

Injection, hepatitis B immune globulin (Hepagam B), intramuscular, 0.5 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.66 / $80.26 / $143.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $71.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $119.95 / $302.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $71.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.87 / $66.64 / $66.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $66.64 / $66.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.92 / $108.22 / $205.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $74.64 / $74.64
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.18 / $64.45 / $97.34