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Maine rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,593.44 / $3,997.67 / $3,997.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,279.18 / $6,839.66 / $12,678.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,952.48 / $3,084.00 / $4,456.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $4,362.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $3,578.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,805.84 / $4,805.84 / $4,805.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,342.16 / $3,997.67 / $3,997.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,318.62 / $4,805.84 / $8,218.87