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Maine rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,842.21 / $2,843.98 / $3,750.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.49 / $446.98 / $769.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.94 / $602.76 / $920.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.74 / $665.33 / $1,031.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.40 / $720.54 / $1,067.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $2,843.98 / $7,611.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.49 / $495.90 / $898.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.64 / $672.66 / $959.19