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Maine rates for HCPCS L5694

Addition To Lower Extremity Above Knee Pelvic Control Belt Padded And Lined

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.85 / $195.53 / $195.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.20 / $334.54 / $620.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.08 / $138.94 / $217.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.85 / $140.85 / $213.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.82 / $102.82 / $140.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.06 / $235.06 / $235.06
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.47 / $195.53 / $195.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.56 / $163.66 / $333.08