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Maine rates for HCPCS L5795

Addition Exoskeletal System Hip Disarticulation Ultra-Light Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.99 / $1,157.24 / $1,157.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,528.21 / $1,979.94 / $3,670.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.30 / $822.37 / $1,289.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.11 / $908.11 / $1,262.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.92 / $662.92 / $908.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.19 / $1,391.19 / $1,391.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$967.49 / $1,157.24 / $1,157.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.48 / $968.67 / $1,971.33