go back

Maine rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.21 / $342.52 / $342.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.32 / $586.03 / $1,086.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.73 / $243.41 / $381.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $373.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $248.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.77 / $411.77 / $411.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.37 / $342.52 / $342.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.15 / $286.70 / $583.48