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Maine rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.73 / $341.78 / $341.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.33 / $584.75 / $1,083.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.11 / $278.49 / $380.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.76 / $366.26 / $372.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.87 / $410.87 / $410.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.74 / $341.78 / $341.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.78 / $253.17 / $582.22