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Maine rates for HCPCS J0121

Injection, omadacycline, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $10.23 / $10.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $3.98 / $4.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $4.79 / $13.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $4.27 / $4.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.27 / $4.27 / $4.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.17 / $4.17 / $5.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $9.55 / $10.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $4.17 / $10.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.55 / $4.17 / $6.03