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Maine rates for HCPCS A5113

Leg Strap; Latex Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.73 / $3.58 / $3.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.80 / $2.80 / $2.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.96 / $4.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.37 / $3.37 / $4.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $5.08 / $5.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.28 / $3.58 / $3.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.15 / $3.11 / $7.16