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Maine rates for HCPCS J1162

Digoxin Immune Fab (Ovine)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,990.30 / $11,990.30 / $12,920.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,374.96 / $6,011.98 / $6,011.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,001.30 / $6,277.85 / $16,378.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $5,168.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $6,258.73
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,990.30 / $11,990.30 / $12,920.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,374.96 / $6,011.98 / $12,920.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,168.22 / $5,168.22 / $7,752.35