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Maine rates for HCPCS 50722

Ureterolysis For Ovarian Vein Syndrome

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.20 / $1,313.20 / $1,447.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,065.14 / $15,647.20 / $17,644.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,216.54 / $1,349.56 / $2,086.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,211.70 / $1,531.78 / $2,194.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.59 / $1,461.27 / $2,241.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,313.20 / $1,313.20 / $1,447.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.96 / $1,560.82 / $2,017.05