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Maine rates for HCPCS J0558

Injection, penicillin G benzathine and penicillin G procaine, 100,000 units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $48.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.30 / $21.02 / $21.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.89 / $23.71 / $61.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $19.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.52 / $19.52 / $23.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.29 / $45.29 / $48.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.30 / $21.02 / $48.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.59 / $19.52 / $28.30