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Maryland rates for HCPCS J3355

Injection, urofollitropin, 75 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.65 / $127.65 / $127.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.65 / $127.65 / $149.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.14 / $120.14 / $120.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.43 / $63.43 / $80.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.81 / $74.09 / $95.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.15 / $125.15 / $150.18
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $125.00 / $125.00