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Maine rates for HCPCS J3095

Injection, telavancin, 10 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $18.62 / $18.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $8.51 / $23.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $7.41 / $8.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $8.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $18.62
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.41 / $18.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $7.41 / $10.96