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Maine rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.64 / $8.64 / $33.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.95 / $24.22 / $29.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.53 / $21.53 / $26.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.21 / $31.93