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Maine rates for HCPCS J1459

Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.72 / $8,023.35 / $9,235.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.77 / $61.02 / $88.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.10 / $61.63 / $160.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $61.45
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.72 / $6,767.18 / $9,836.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.77 / $58.35 / $102.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $76.11