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Maine rates for HCPCS 40801

Drg Absc Cst Hmtma Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.49 / $252.44 / $365.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.44 / $358.38 / $451.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.27 / $386.80 / $641.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.27 / $366.03 / $569.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.49 / $252.44 / $365.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.88 / $461.30 / $594.01