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Maine rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.13 / $86.52 / $86.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.26 / $148.04 / $274.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.87 / $61.49 / $96.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $94.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $60.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.02 / $104.02 / $104.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.34 / $86.52 / $86.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.73 / $72.43 / $147.38