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Maine rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.02 / $139.94 / $152.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.45 / $169.85 / $232.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.96 / $203.81 / $310.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.87 / $148.38 / $263.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.02 / $139.94 / $146.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.31 / $177.10 / $249.17