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Maine rates for HCPCS L5590

Preparatory, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,454.33 / $2,241.77 / $2,241.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.40 / $3,835.48 / $7,109.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.40 / $1,841.24 / $2,498.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,289.62 / $2,289.62 / $2,446.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,671.42 / $1,671.42 / $2,289.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,694.97 / $2,694.97 / $2,694.97
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,874.19 / $2,241.77 / $2,241.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.07 / $1,660.57 / $4,608.89