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Maine rates for HCPCS J7170

Injection Emicizumab-Kxwh 0.5 Mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.15 / $130.15 / $140.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.35 / $69.48 / $84.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.29 / $68.14 / $177.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $56.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $67.94
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.15 / $130.15 / $140.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.35 / $69.48 / $140.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $56.10 / $84.15