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Maine rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.73 / $466.65 / $466.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.24 / $798.39 / $1,479.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.85 / $365.18 / $520.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.73 / $493.58 / $509.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $493.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.98 / $560.98 / $560.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.14 / $466.65 / $466.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.44 / $376.73 / $794.92