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Maine rates for HCPCS L5706

Custom shaped protective cover, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $660.69 / $1,949.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,513.56 / $1,737.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $954.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,348.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $776.25 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $588.84 / $724.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $812.83 / $1,148.15