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Maine rates for HCPCS J3101

Injection, tenecteplase, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.11 / $399.55 / $16,165.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.11 / $208.05 / $208.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.66 / $209.20 / $545.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $172.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.22 / $172.22 / $172.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $172.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.22 / $172.22 / $208.56
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.88 / $399.55 / $16,165.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.21 / $179.11 / $430.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.38 / $172.22 / $265.51