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Maine rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.20 / $857.36 / $857.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,132.21 / $1,466.88 / $2,719.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.25 / $609.27 / $955.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $935.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $596.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.69 / $1,030.69 / $1,030.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.78 / $857.36 / $857.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.38 / $629.41 / $629.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.39 / $635.08 / $1,460.48