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Maine rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.20 / $391.85 / $391.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.46 / $670.42 / $1,242.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.64 / $278.51 / $436.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $427.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $227.60 / $311.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.06 / $471.06 / $471.06
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.60 / $391.85 / $391.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $290.26 / $667.51