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Maine rates for HCPCS J0841

Injection, crotalidae immune F(ab')2 (equine), 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,424.75 / $2,424.75 / $2,612.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.96 / $1,263.41 / $1,263.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.39 / $1,269.54 / $3,312.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,045.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,265.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,424.75 / $2,424.75 / $2,612.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,086.96 / $1,263.41 / $2,612.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.15 / $1,045.15 / $1,567.73