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Maine rates for HCPCS L5961

Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,705.97 / $3,689.44 / $3,689.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,872.14 / $6,312.32 / $11,701.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,159.00 / $3,159.00 / $3,569.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.42 / $3,728.42 / $3,728.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.75 / $2,721.75 / $3,728.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.31 / $4,435.31 / $4,435.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,084.50 / $3,689.44 / $3,689.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,974.37 / $3,860.90 / $6,284.88