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Maine rates for HCPCS J7100

Infusion Dextran 40 500 Ml (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.30 / $185.30 / $199.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.89 / $67.89 / $67.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.80 / $205.80 / $205.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.88 / $67.88 / $67.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.89 / $67.89 / $67.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.89 / $67.89 / $67.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.77 / $17.77 / $21.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.30 / $185.30 / $199.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.89 / $67.89 / $199.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.58 / $66.56 / $99.84