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Maine rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.30 / $1,677.56 / $1,677.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,215.32 / $2,870.15 / $5,320.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.33 / $1,192.11 / $1,869.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $1,830.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $852.13 / $1,167.30
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.70 / $2,016.70 / $2,016.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.49 / $1,677.56 / $1,677.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.42 / $1,404.20 / $2,857.67