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Maine rates for HCPCS L5672

Addition to lower extremity, below knee (BK), removable medial brim suspension

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.86 / $283.41 / $283.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$374.26 / $484.89 / $898.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.64 / $228.39 / $315.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.02 / $297.81 / $309.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.40 / $217.40 / $297.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.71 / $340.71 / $340.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.94 / $283.41 / $283.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.96 / $209.93 / $582.66