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Maine rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,350.06 / $2,903.79 / $2,903.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,834.64 / $4,968.13 / $9,209.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,574.31 / $2,689.70 / $3,236.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,022.59 / $3,249.00 / $3,249.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.77 / $2,371.77 / $3,249.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,490.81 / $3,490.81 / $3,490.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,427.65 / $2,903.79 / $2,903.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,620.14 / $3,240.28 / $5,969.93