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Maine rates for HCPCS L5649

Addition To Lower Extremity Ischial Containment/Narrow M-L Socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.46 / $1,539.07 / $1,539.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,032.45 / $2,633.22 / $4,881.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.34 / $1,458.34 / $1,715.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,602.04 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $1,800.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,850.22 / $1,850.22 / $1,850.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.71 / $1,539.07 / $1,539.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$760.04 / $1,503.39 / $2,621.77