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Maine rates for HCPCS 50920

Closure Ureterocutaneous Fistula

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.33 / $1,129.33 / $1,269.92
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
$1,061.39 / $1,169.63 / $1,803.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.16 / $1,317.77 / $1,887.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.55 / $1,262.88 / $1,937.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,129.33 / $1,129.33 / $1,269.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.66 / $1,259.81 / $1,748.08