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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
$69.98 / $282.33 / $1,774.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.37 / $33.11 / $33.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.28 / $93.28 / $93.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $30.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $36.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.22 / $75.43 / $605.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.37 / $33.11 / $75.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $30.17 / $46.88