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Maine rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.02 / $551.87 / $551.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.77 / $944.19 / $1,750.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.72 / $392.18 / $615.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.18 / $452.18 / $602.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.09 / $330.09 / $452.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.43 / $663.43 / $663.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.38 / $551.87 / $551.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.52 / $408.79 / $940.09