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Maine rates for HCPCS J1557

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.74 / $147.74 / $159.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.23 / $75.59 / $75.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.62 / $77.34 / $201.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $63.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.68 / $63.68 / $77.12
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.74 / $147.74 / $159.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.23 / $75.59 / $159.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.62 / $63.68 / $111.44