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Maine rates for HCPCS 15842

Graft for facial nerve paralysis; free muscle flap by microsurgical technique

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,171.37 / $2,171.37 / $2,171.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,628.80 / $3,333.77 / $5,125.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.14 / $3,736.60 / $5,793.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,349.95 / $4,013.58 / $5,945.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,171.37 / $2,171.37 / $2,171.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,647.93 / $3,683.36 / $5,322.24