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Maine rates for HCPCS 74455

Urethrocystography Voiding Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.39 / $635.39 / $665.57
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$18.46 / $18.46 / $18.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.89 / $98.50 / $173.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.48 / $15.90 / $23.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.84 / $82.69 / $149.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.86 / $399.00 / $654.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.33 / $135.65 / $198.39
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.88 / $20.54 / $29.24
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.45 / $111.40 / $169.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.90 / $140.18 / $238.17
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.26 / $24.78 / $35.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.77 / $120.41 / $204.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.31 / $150.79 / $272.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.96 / $22.82 / $41.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$106.35 / $127.98 / $230.86
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.39 / $635.39 / $665.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.59 / $110.67 / $193.34
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.19 / $18.46 / $34.13
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.40 / $92.20 / $164.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.72 / $118.67 / $246.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.60 / $23.52 / $38.45
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.79 / $86.91 / $191.93