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Maine rates for HCPCS L5828

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,974.56 / $3,043.69 / $3,043.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,019.39 / $5,207.49 / $9,653.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,063.67 / $2,162.92 / $3,392.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $2,117.90 / $3,321.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $2,117.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,659.00 / $3,659.00 / $3,659.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,544.61 / $3,043.69 / $3,043.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.06 / $2,547.73 / $5,184.84