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Maine rates for HCPCS 57180

Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.37 / $155.11 / $176.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.62 / $209.37 / $290.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.53 / $249.35 / $377.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.44 / $242.37 / $377.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.37 / $148.18 / $194.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.33 / $233.28 / $379.56