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Maine rates for HCPCS J3240

Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,200.98 / $4,909.85 / $5,290.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.48 / $2,201.81 / $2,906.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,047.96 / $2,570.69 / $6,706.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,116.32 / $2,116.32 / $2,116.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,116.32 / $2,116.32 / $2,116.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,116.32 / $2,116.32 / $2,116.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.49 / $1,982.49 / $2,400.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,909.85 / $4,909.85 / $5,290.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.48 / $2,315.25 / $3,703.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,944.38 / $2,116.32 / $3,068.66