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Maine rates for HCPCS L5930

Addition Endoskeletal System High Activity Knee Control Frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,820.29 / $2,805.88 / $2,805.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,705.35 / $4,800.62 / $8,898.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,207.84 / $2,331.25 / $3,127.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $2,282.71 / $3,062.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $1,666.39 / $2,282.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,373.12 / $3,373.12 / $3,373.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,345.81 / $2,805.88 / $2,805.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,982.23 / $1,982.23 / $1,982.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,385.62 / $2,746.00 / $4,779.75