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Maine rates for HCPCS L2627

Addition to lower extremity, pelvic control, plastic, molded to patient model, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.11 / $1,563.02 / $1,563.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.28 / $2,967.26 / $5,500.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.26 / $1,232.45 / $1,232.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.80 / $1,206.80 / $1,892.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.96 / $880.96 / $1,206.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,084.92 / $2,084.92 / $2,084.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,449.94 / $1,563.02 / $1,563.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.45 / $1,284.68 / $3,056.24