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Maine rates for HCPCS J2810

Injection, theophylline, per 40 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
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
$0.42 / $0.42 / $0.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.09 / $1.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $1.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.05 / $1.52