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Maine rates for HCPCS L5814

Addition Endoskeletal Knee-Shin System Polycentric Hydraulic Swing Phase Control Mechanical Stance Phase Lock

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.96 / $2,947.18 / $2,947.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,891.93 / $5,042.35 / $9,346.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,555.87 / $2,555.87 / $3,285.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,502.67 / $2,502.67 / $3,216.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.95 / $1,826.95 / $2,502.67
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,542.98 / $3,542.98 / $3,542.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.94 / $2,947.18 / $2,947.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.40 / $2,248.86 / $5,020.45