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Maine rates for HCPCS J7121

5% Dextrose In Lac Ringers

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $22.23 / $23.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.67 / $24.67 / $24.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $8.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.14 / $9.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.12 / $22.23 / $23.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.14 / $8.27 / $23.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.78 / $7.98 / $11.57