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New Hampshire rates for HCPCS J3415

Injection, pyridoxine HCl, 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.80 / $14.34 / $25.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $12.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.23 / $9.08 / $24.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $12.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.70 / $6.05 / $6.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.21 / $10.07 / $18.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $6.05 / $6.05
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $19.44 / $29.81