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Maine rates for HCPCS 49426

Revis Peritoneal-Venous Shunt

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.09 / $798.74 / $798.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.21 / $890.52 / $1,389.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.00 / $611.00 / $763.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.79 / $971.87 / $1,440.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.56 / $970.53 / $1,518.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.09 / $798.74 / $1,578.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$634.78 / $875.62 / $1,402.09