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Maine rates for HCPCS L2624

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $234.42 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $446.68 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $288.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $389.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $229.09 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $186.21 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $389.05