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Maine rates for HCPCS 64640

Dstrj Neurolytic Agent Other Peripheral Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,723.32 / $1,723.32 / $1,723.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.05 / $190.29 / $293.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.09 / $142.19 / $237.22
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$175.63 / $198.70 / $355.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.94 / $279.83 / $518.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.22 / $307.08 / $493.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,723.32 / $1,723.32 / $1,723.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.05 / $193.70 / $347.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.35 / $222.58 / $505.98