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Maine rates for HCPCS J1558

Injection, immune globulin (xembify), 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $34.45 / $37.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.44 / $18.04 / $18.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.36 / $18.03 / $47.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $14.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.84 / $14.84 / $14.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $17.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.45 / $34.45 / $37.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.44 / $18.04 / $37.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.85 / $14.85 / $23.11