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Maine rates for HCPCS Q0139

Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD on dialysis)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.42 / $0.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.36 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.52