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Maryland rates for HCPCS 15121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,434.69 / $2,434.69 / $2,434.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.63 / $275.83 / $499.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $150.00 / $150.00