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Maine rates for HCPCS J1454

Injection, fosnetupitant 235 mg and palonosetron 0.25 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.16 / $1,335.16 / $1,438.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $598.52 / $733.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.85 / $639.78 / $1,823.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $575.50 / $597.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.50 / $575.50 / $708.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $575.50 / $575.50
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.37 / $858.37 / $858.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $575.50 / $575.50
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.16 / $1,335.16 / $1,438.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $604.28 / $790.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.50 / $575.50 / $834.48