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Maine rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.40 / $299.64 / $299.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.70 / $512.66 / $950.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.82 / $212.94 / $334.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $209.59 / $327.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $209.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.23 / $360.23 / $360.23
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.52 / $299.64 / $299.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.04 / $219.98 / $219.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.97 / $221.96 / $510.44