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Maine rates for HCPCS J1212

Injection, DMSO, dimethyl sulfoxide, 50%, 50 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,862.09 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $741.31 / $891.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $870.96 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $912.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,862.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $776.25 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $741.31 / $1,096.48