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Maine rates for HCPCS J9309

Injection, polatuzumab vedotin-piiq, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.07 / $19,842.91 / $19,842.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $142.19 / $187.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.55 / $151.94 / $433.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $141.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.91 / $136.66 / $136.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $136.66 / $136.66
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.07 / $317.07 / $19,842.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.59 / $149.51 / $187.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.38 / $136.66 / $198.17