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Maine rates for HCPCS J2779

Injection, ranibizumab, via intravitreal implant (Susvimo), 0.1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $89.13 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $93.33
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $190.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $79.43 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $109.65