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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
$281.84 / $363.08 / $1,071.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $812.83 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $724.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $380.19 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $331.13 / $380.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $426.58 / $660.69