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Maine rates for HCPCS J1580

Injection, garamycin, gentamicin, up to 80 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $41.18 / $97.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $2.29 / $3.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.83 / $6.83 / $6.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.21
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $3.65 / $3.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.13 / $18.89 / $97.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.20 / $2.29 / $4.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $3.32