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Maine rates for HCPCS J1110

Injection Dihydroergotamine Mesylate Per 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.19 / $150.00 / $861.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.40 / $117.46 / $117.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.51 / $185.51 / $185.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $60.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $72.66
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.19 / $139.19 / $861.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.40 / $117.46 / $150.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $100.83