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Maine rates for HCPCS 80376

Drug/Substance Definitive Qual/Quant Nos 4-6

Insurance Carrier
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.93 / $8.93 / $33.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.22 / $25.60 / $30.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.37 / $22.37 / $27.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $14.55 / $33.03