go back

Maine rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,484.69 / $2,288.57 / $2,288.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,022.20 / $3,915.54 / $7,258.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,988.34 / $2,112.61 / $2,551.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,382.19 / $2,482.86 / $2,497.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,812.49 / $2,482.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,751.23 / $2,751.23 / $2,751.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,913.32 / $2,288.57 / $2,288.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.98 / $2,182.50 / $2,182.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.16 / $1,695.24 / $3,898.53