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Maine rates for HCPCS J9266

Injection, pegaspargase, per single dose vial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66,069.34 / $70,794.58 / $70,794.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $33,113.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,542.29 / $33,113.11 / $89,125.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $29,512.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $40,738.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $28,183.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $28,183.83 / $28,840.32
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66,069.34 / $66,069.34 / $70,794.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28,183.83 / $29,512.09 / $42,657.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23,988.33 / $28,183.83 / $33,884.42