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Maine rates for HCPCS L5637

Addition To Lower Extremity Below Knee Total Contact

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.43 / $268.87 / $268.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.06 / $460.01 / $852.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.73 / $221.26 / $299.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $293.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $170.08 / $232.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.22 / $323.22 / $323.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.78 / $268.87 / $268.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.28 / $199.16 / $552.77