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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
$131.83 / $141.25 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $67.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $66.07 / $177.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $67.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $141.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $58.88 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $56.23 / $81.28