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Maine rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,465.01 / $2,258.25 / $2,258.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,982.17 / $3,863.67 / $7,162.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.36 / $1,780.13 / $2,517.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,743.07 / $2,464.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.44 / $1,272.44 / $1,743.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.77 / $2,714.77 / $2,714.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.97 / $2,258.25 / $2,258.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.18 / $1,672.78 / $3,846.86