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Maine rates for HCPCS J7196

Injection, antithrombin recombinant, 50 IU

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.15 / $391.15 / $421.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.41 / $434.41 / $434.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $143.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $173.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.15 / $391.15 / $421.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.31 / $143.31 / $421.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.43 / $140.50 / $203.73