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Maine rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,093.14 / $3,226.46 / $3,226.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,260.75 / $5,520.20 / $10,232.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,776.59 / $2,913.71 / $3,596.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,853.06 / $2,853.06 / $3,521.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,082.73 / $2,853.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,878.73 / $3,878.73 / $3,878.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,697.42 / $3,226.46 / $3,226.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.08 / $2,389.96 / $5,496.20