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Maine rates for HCPCS J2560

Injection, phenobarbital sodium, up to 120 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $72.44 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $28.84 / $35.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $23.99 / $28.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $72.44 / $602.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $30.20 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $43.65