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Maine rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,231.36 / $3,439.53 / $3,439.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,542.10 / $5,884.73 / $10,908.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.31 / $2,660.78 / $3,834.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $3,753.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,194.96 / $2,194.96 / $3,006.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,134.85 / $4,134.85 / $4,134.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,875.54 / $3,439.53 / $3,439.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.53 / $3,134.16 / $5,859.13