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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
$557.16 / $858.84 / $858.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.15 / $1,469.40 / $2,723.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.97 / $698.03 / $957.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$893.99 / $957.73 / $957.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $699.14 / $957.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.47 / $1,032.47 / $1,032.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.01 / $858.84 / $858.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.12 / $636.17 / $1,463.01