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Maine rates for HCPCS J3250

Injection, trimethobenzamide HCl, up to 200 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.41 / $133.41 / $143.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $59.81 / $64.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.82 / $177.82 / $177.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $59.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.51 / $57.51 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $57.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $57.51
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.41 / $133.41 / $143.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $60.38 / $89.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $57.51 / $83.39