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Maine rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.59 / $2,641.40 / $2,641.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,488.15 / $4,519.22 / $8,377.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.71 / $1,877.05 / $2,944.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $2,882.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $1,902.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,175.39 / $3,175.39 / $3,175.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,208.29 / $2,641.40 / $2,641.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,304.40 / $2,210.98 / $4,499.55