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Maine rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.85 / $402.09 / $402.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.99 / $687.95 / $1,275.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.05 / $381.05 / $448.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $380.63 / $438.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $277.86 / $380.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.38 / $483.38 / $483.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.16 / $402.09 / $402.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.21 / $483.38 / $684.95