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Maine rates for HCPCS L5830

Addition, endoskeletal knee-shin system, single axis, pneumatic/swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,326.80 / $2,045.19 / $2,045.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,700.81 / $3,499.15 / $6,486.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.42 / $1,453.36 / $2,279.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.54 / $1,654.54 / $2,231.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.81 / $1,207.81 / $1,654.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,458.65 / $2,458.65 / $2,458.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,709.84 / $2,045.19 / $2,045.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,009.97 / $2,458.65 / $3,363.81