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Maine rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.89 / $357.45 / $357.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.04 / $611.57 / $1,133.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.07 / $254.01 / $398.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $390.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $306.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.72 / $429.72 / $429.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.83 / $357.45 / $357.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.52 / $264.77 / $608.90