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Maine rates for HCPCS J0850

Injection, cytomegalovirus immune globulin intravenous (human), per vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,196.07 / $4,196.07 / $4,521.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,880.99 / $2,189.42 / $2,189.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,750.22 / $2,196.96 / $5,731.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $1,808.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,808.65 / $1,808.65 / $2,190.28
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,196.07 / $4,196.07 / $4,521.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,880.99 / $2,189.42 / $4,521.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.83 / $1,808.65 / $2,712.98