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Maine rates for HCPCS L5614

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.36 / $1,339.12 / $1,339.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,768.39 / $2,291.11 / $4,246.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.77 / $1,161.30 / $1,492.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $1,461.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $961.99 / $1,317.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.83 / $1,609.83 / $1,609.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.53 / $1,339.12 / $1,339.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.29 / $1,197.35 / $2,281.14