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Maine rates for HCPCS L5695

Addition To Lower Extremity Above Knee Pelvic Control Sleeve Suspension Neoprene Or Equal Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.29 / $148.41 / $148.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.01 / $253.94 / $470.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.12 / $124.91 / $165.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $161.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $122.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.43 / $178.43 / $178.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.09 / $148.41 / $148.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.30 / $109.94 / $252.85