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Maine rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.11 / $2,223.38 / $2,816.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,311.67 / $2,991.59 / $4,197.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,224.69 / $3,345.33 / $4,761.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,738.24 / $3,168.14 / $4,860.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.11 / $2,373.56 / $3,435.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,831.32 / $11,831.32 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,844.98 / $2,951.96 / $4,359.07