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Maine rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.65 / $1,543.92 / $1,543.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,038.83 / $2,641.50 / $4,896.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.47 / $1,101.44 / $1,721.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $1,684.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.89 / $899.89 / $1,232.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,856.04 / $1,856.04 / $1,856.04
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.77 / $1,543.92 / $1,543.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.43 / $1,297.40 / $2,630.02