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Maine rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $457.09 / $1,174.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $912.01 / $1,047.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $575.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $812.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $512.86 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $467.74 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $575.44 / $776.25