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Maine rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.98 / $365.29 / $365.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.38 / $624.97 / $1,158.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.79 / $277.67 / $407.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $398.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $274.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.13 / $439.13 / $439.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.39 / $365.29 / $365.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.39 / $270.58 / $622.27