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Maine rates for HCPCS 17004

Destruction Premalignant Lesion 15/>

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $464.00 / $464.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.45 / $143.82 / $275.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.28 / $161.72 / $254.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.69 / $192.45 / $322.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.84 / $206.10 / $346.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.00 / $464.00 / $464.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.45 / $143.82 / $286.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.93 / $205.52 / $346.99