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Maine rates for HCPCS J1575

Injection, immune globulin/hyaluronidase, 100 mg immuneglobulin

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.11 / $42.11 / $45.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.88 / $22.25 / $22.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.55 / $22.05 / $57.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $18.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.14 / $18.14 / $21.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.11 / $42.11 / $45.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.88 / $22.25 / $45.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.28 / $18.14 / $27.23