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Maine rates for HCPCS L2628

Addition To Lower Extremity Pelvic Control Metal Frame Reciprocating Hip Joint And Cables

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.72 / $1,336.02 / $1,336.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,957.66 / $2,536.33 / $4,701.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.16 / $1,204.48 / $1,204.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,617.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.97 / $860.97 / $1,179.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,782.13 / $1,782.13 / $1,782.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,239.35 / $1,336.02 / $1,336.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.07 / $1,098.09 / $2,525.31