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Maine rates for HCPCS J3095

Injection, telavancin, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.50 / $16.50 / $17.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $9.03 / $9.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.88 / $8.64 / $22.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $7.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $8.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.50 / $16.50 / $17.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.40 / $9.03 / $17.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.11 / $7.11 / $10.67