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Maine rates for HCPCS L5705

Custom shaped protective cover, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,995.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,548.82 / $1,778.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $891.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,380.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $602.56 / $741.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $831.76 / $1,174.90