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Maine rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.83 / $442.14 / $442.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.87 / $756.46 / $1,402.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.40 / $369.80 / $492.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.22 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.52 / $531.52 / $531.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.64 / $442.14 / $442.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.34 / $327.51 / $753.17