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Maine rates for HCPCS J3105

Injection Terbutaline Sulfate Up To 1 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.72 / $17.14 / $166.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $7.69 / $8.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.85 / $22.85 / $22.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $7.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.39 / $7.39 / $8.94
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.68 / $16.95 / $37.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.32 / $7.69 / $18.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.28 / $7.39 / $12.93