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Maine rates for HCPCS J2997

Injection, alteplase recombinant, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $436.52 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $95.50 / $181.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $109.65 / $295.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $114.82
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $398.11 / $1,513.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $97.72 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $93.33 / $134.90