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Maine rates for HCPCS L5668

Addition To Lower Extremity Below Knee Molded Distal Cushion

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.97 / $100.14 / $100.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.25 / $171.35 / $317.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.34 / $77.34 / $111.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $89.19 / $109.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $65.11 / $89.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.39 / $120.39 / $120.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.73 / $100.14 / $100.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.45 / $91.11 / $170.61