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Maine rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.42 / $1,182.41 / $1,182.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.45 / $2,023.00 / $3,750.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.70 / $983.70 / $1,450.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $1,290.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $703.15 / $963.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.44 / $1,421.44 / $1,421.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.53 / $1,182.41 / $1,182.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.15 / $1,281.73 / $1,944.74