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Maine rates for HCPCS 50930

Closure Ureterocutaneous Fistula W/Visc Rpr

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.33 / $1,412.33 / $1,626.84
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
$1,325.91 / $1,467.00 / $2,243.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.11 / $1,642.66 / $2,353.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.14 / $1,571.44 / $2,410.67
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.33 / $1,412.33 / $1,626.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,165.95 / $1,645.81 / $2,174.25