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Illinois rates for HCPCS J9210

Injection Emapalumab-Lzsg 1 Mg (Reinstated) Hexamethylmelamine (Deleted 3/31/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.64 / $623.46 / $1,278.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.64 / $384.85 / $462.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,070.11 / $1,635.15 / $8,102.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $384.85 / $384.85
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.12 / $461.82 / $1,699.35
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.31 / $500.31 / $500.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.85 / $404.77 / $439.13