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Maine rates for HCPCS J1428

Inj, eteplirsen, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.44 / $445.44 / $480.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.94 / $203.28 / $530.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $163.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $197.64
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.44 / $445.44 / $480.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.19 / $163.19 / $480.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $240.00