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Maine rates for HCPCS L5728

Addition, exoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.80 / $2,564.66 / $2,564.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,386.80 / $4,387.91 / $8,133.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,715.30 / $1,822.51 / $2,858.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.41 / $2,050.41 / $2,798.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.80 / $1,496.80 / $2,050.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,083.14 / $3,083.14 / $3,083.14
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,144.13 / $2,564.66 / $2,564.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.50 / $1,899.75 / $4,368.84