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Maine rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.76 / $531.41 / $531.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$701.77 / $909.21 / $1,685.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.88 / $377.65 / $592.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $579.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $400.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.86 / $638.86 / $638.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.29 / $531.41 / $531.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.43 / $492.06 / $874.05