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Maine rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $93.33 / $288.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $223.87 / $257.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $100.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $199.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $112.20 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $104.71 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $120.23 / $169.82