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Maine rates for HCPCS L5642

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.65 / $500.83 / $500.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.38 / $856.88 / $1,588.39
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.30 / $474.54 / $558.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.32 / $530.41 / $546.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $530.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.07 / $602.07 / $602.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.71 / $500.83 / $500.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.83 / $370.99 / $853.15