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Maine rates for HCPCS 80050

General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.26 / $386.88 / $547.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.17 / $38.36 / $46.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.36 / $17.36 / $62.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.72 / $42.66 / $100.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.61 / $43.52 / $58.85
Community Health Options
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.43 / $265.43 / $265.43
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.92 / $39.92 / $211.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.88 / $49.88 / $60.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.04 / $332.54 / $611.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.36 / $39.90 / $94.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.46 / $25.04 / $60.52