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Maine rates for HCPCS 76513

Dx Ophthalmic Us Ant Segment Immersion Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.20 / $88.94 / $124.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.14 / $33.40 / $50.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.86 / $55.88 / $73.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.06 / $102.32 / $143.07
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.18 / $42.94 / $60.40
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$118.60 / $153.47 / $214.61
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.89 / $59.38 / $82.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.45 / $126.29 / $167.70
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.49 / $49.47 / $70.41
Cigna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$145.44 / $145.44 / $145.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.49 / $75.51 / $111.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $110.13 / $163.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.57 / $47.62 / $77.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.35 / $62.72 / $92.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.14 / $91.01 / $124.65
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.80 / $34.26 / $51.26
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.89 / $56.75 / $79.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.25 / $130.72 / $169.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.54 / $50.79 / $65.70
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.70 / $79.92 / $103.36