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Maine rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,890.45 / $10,232.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $7,943.28 / $9,120.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $6,760.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,365.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $7,079.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,168.69 / $10,232.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,073.80 / $4,365.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,677.35 / $6,606.93