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Maine rates for HCPCS J1260

Injection Dolasetron Mesylate 10 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.32 / $16.32 / $17.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $5.98
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
$5.98 / $5.98 / $5.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $6.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.17 / $6.17 / $7.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.32 / $16.32 / $17.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.98 / $5.98 / $17.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.37 / $12.20 / $17.69