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Maine rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.42 / $1,982.94 / $1,982.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,618.61 / $3,392.65 / $6,288.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,758.58 / $1,758.58 / $2,210.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $2,163.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $1,721.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,383.82 / $2,383.82 / $2,383.82
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,657.79 / $1,982.94 / $1,982.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.29 / $2,118.58 / $4,076.77