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Maine rates for HCPCS J1568

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.42 / $110.27 / $118.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $49.43 / $58.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.99 / $57.72 / $150.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $47.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.52 / $47.52 / $47.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $57.56
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.27 / $110.27 / $6,098.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $51.99 / $65.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.53 / $47.53 / $83.18