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Maine rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.54 / $255.18 / $255.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.98 / $436.59 / $809.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.58 / $203.16 / $284.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $278.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $221.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.77 / $306.77 / $306.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.33 / $255.18 / $255.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.02 / $239.30 / $434.70