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Maryland rates for HCPCS 40701

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 Stg Px

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,580.63 / $6,580.63 / $6,580.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.32 / $1,400.73 / $2,764.90
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,270.09 / $1,289.99 / $1,530.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.86 / $1,269.82 / $2,151.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,245.95 / $1,442.68 / $2,623.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,236.00 / $1,236.00 / $1,236.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.70 / $1,213.33 / $2,615.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.23 / $1,311.53 / $1,434.61