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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
$2,089.30 / $2,884.03 / $7,413.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,623.41 / $6,456.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $4,897.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,884.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $5,011.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $3,019.95 / $7,413.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $3,019.95 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,467.37 / $4,897.79