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Maine rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.88 / $3,175.20 / $3,175.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,193.06 / $5,432.50 / $10,070.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,753.59 / $2,753.59 / $3,539.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $3,465.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $2,886.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,817.10 / $3,817.10 / $3,817.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,654.56 / $3,175.20 / $3,175.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.00 / $2,352.00 / $5,408.86