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Maine rates for HCPCS L5656

Addition To Lower Extremity Socket Insert Knee Disarticulation (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.73 / $302.76 / $302.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.82 / $518.00 / $960.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.76 / $284.13 / $337.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.14 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $335.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.97 / $363.97 / $363.97
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.13 / $302.76 / $302.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.14 / $224.27 / $515.75