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Maryland rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.51 / $505.51 / $505.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $677.38
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.50 / $505.50 / $508.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $647.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $537.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $539.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.92 / $484.92 / $484.92