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Maine rates for HCPCS L5855

Addition Endoskeletal System Hip Disarticulation Mechanical Hip Extension Assist

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $249.65 / $249.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.68 / $427.13 / $791.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.02 / $236.54 / $278.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.78 / $239.78 / $272.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.04 / $175.04 / $239.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.12 / $300.12 / $300.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.71 / $249.65 / $249.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.02 / $247.02 / $247.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.47 / $278.63 / $425.27