go back

New Hampshire rates for HCPCS J3095

Telavancin Injection

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.47 / $8.36 / $14.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.47 / $12.80 / $32.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.71 / $7.11 / $7.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $11.55 / $21.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $17.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.19 / $2.79