go back

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
$1,513.56 / $1,995.26 / $6,918.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,370.32 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,137.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $4,786.30
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,630.27 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,187.76 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,570.40 / $3,981.07