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Maine rates for HCPCS L5696

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Joint

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.34 / $191.67 / $191.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.11 / $327.92 / $607.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.38 / $141.71 / $213.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.76 / $138.76 / $209.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $138.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.42 / $230.42 / $230.42
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.24 / $191.67 / $191.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.65 / $170.72 / $394.07