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Maine rates for HCPCS J1050

Injection Medroxyprogesterone Acetate 1 Mg (Reinstated) Injection Medroxyprogesterone Acetate 100 Mg Special Coverage Instructions Apply. See Mcm: 2049) (Old Description - Deleted 06/30/2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.63 / $412.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.03 / $0.03 / $0.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.69
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $83.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.55 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.70