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Maine rates for HCPCS L5616

Addition to lower extremity, endoskeletal system, above knee (AK), universal multiplex system, friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.06 / $1,239.44 / $1,239.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.75 / $2,120.55 / $3,930.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.06 / $1,040.25 / $1,381.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $1,018.60 / $1,352.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.58 / $743.58 / $1,018.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,490.00 / $1,490.00 / $1,490.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.20 / $1,239.44 / $1,239.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.60 / $1,072.61 / $2,111.35