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Maine rates for HCPCS J2820

Injection Sargramostim (Gm-Csf) 50 Mcg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.86 / $116.86 / $125.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.38 / $55.95 / $67.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.73 / $61.17 / $159.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $50.37 / $50.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.37 / $50.37 / $60.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $50.37 / $50.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.37 / $50.37 / $61.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.86 / $116.86 / $125.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.86 / $55.95 / $125.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.80 / $50.37 / $75.56