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Vermont rates for HCPCS 12004

Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.26 / $134.75 / $190.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.61 / $667.61 / $827.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $141.82 / $380.10
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.71 / $174.84 / $380.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.15 / $181.54 / $527.74