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Maine rates for HCPCS L5645

Addition to lower extremity, below knee (BK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.02 / $718.34 / $718.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$948.61 / $1,229.01 / $2,278.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.85 / $611.12 / $800.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.09 / $694.09 / $783.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.69 / $506.69 / $694.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.56 / $863.56 / $863.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.54 / $718.34 / $718.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.63 / $863.56 / $1,476.84