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Maine rates for HCPCS L5200

Above Knee Molded Socket Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,196.84 / $3,386.32 / $3,386.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,471.85 / $5,793.70 / $10,739.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.26 / $2,530.21 / $3,774.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $3,695.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $2,728.17
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,070.90 / $4,070.90 / $4,070.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,831.07 / $3,386.32 / $3,386.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,672.26 / $2,980.36 / $5,768.51