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Maine rates for HCPCS 15120

Split Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/</1 %

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,751.60 / $2,751.60 / $5,188.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.70 / $813.36 / $1,361.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.77 / $902.86 / $1,356.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.19 / $1,143.49 / $1,686.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.67 / $1,060.79 / $1,768.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,751.60 / $2,751.60 / $5,188.14
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.70 / $813.36 / $1,361.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.52 / $1,174.30 / $1,701.01