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Maine rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.82 / $1,655.14 / $1,655.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,185.71 / $2,831.80 / $5,249.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.38 / $1,332.19 / $1,845.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,806.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,182.59 / $1,620.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,989.74 / $1,989.74 / $1,989.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.75 / $1,655.14 / $1,655.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.35 / $1,226.03 / $2,819.48