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Maine rates for HCPCS J9325

Injection, talimogene laherparepvec, per 1 million plaque forming units

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $186.21 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $87.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $85.11 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $186.21
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $75.86 / $114.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $74.13 / $87.10