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Maine rates for HCPCS J7503

Tacrolimus Extended Release (Envarsus Xr) Oral 0.25 Mg (Reinstated 01/01/2016) Cyclosporine Parenteral 250 Mg/5 Ml (Del 12/31/99)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.25 / $4.25 / $4.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.90 / $2.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.66 / $5.66 / $5.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.83 / $1.83 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.25 / $4.25 / $4.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.92 / $3.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.65