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Maine rates for HCPCS L5790

Addition, exoskeletal system, above knee (AK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.76 / $774.98 / $774.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.40 / $1,325.91 / $2,457.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.50 / $550.74 / $863.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.20 / $582.20 / $845.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.01 / $425.01 / $582.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.64 / $931.64 / $931.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.90 / $774.98 / $774.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.36 / $500.36 / $500.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.70 / $574.05 / $1,320.15