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New Hampshire rates for HCPCS J2250

Injection Midazolam Hydrochloride Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.16 / $5.67 / $12.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.14 / $0.15 / $0.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.18 / $0.23 / $0.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.15 / $0.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.25 / $0.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.15 / $0.15
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.36 / $0.63