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Maine rates for HCPCS L5698

Addition To Lower Extremity Above Knee Or Knee Disarticulation Silesian Bandage

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.01 / $97.12 / $97.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.26 / $166.17 / $308.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.13 / $79.89 / $108.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.25 / $99.25 / $106.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $99.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.76 / $116.76 / $116.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.20 / $97.12 / $97.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.54 / $82.54 / $82.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.13 / $94.11 / $165.45