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Maine rates for HCPCS L5653

Addition to lower extremity, knee disarticulation, expandable wall socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.61 / $492.66 / $492.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.59 / $842.90 / $1,562.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.79 / $445.77 / $549.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.79 / $555.76 / $555.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.70 / $405.70 / $555.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.26 / $592.26 / $592.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.87 / $492.66 / $492.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.29 / $525.07 / $839.23