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Maine rates for HCPCS J1458

Injection, galsulfase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,180.32 / $1,180.32 / $1,271.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.11 / $611.66 / $611.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.33 / $617.99 / $1,612.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $508.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.76 / $508.76 / $616.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,180.32 / $1,180.32 / $1,271.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$529.11 / $611.66 / $1,271.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.62 / $508.76 / $763.14