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Maine rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.94 / $101.65 / $101.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.22 / $173.91 / $322.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.15 / $88.15 / $113.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.20 / $122.20 / $122.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.98 / $101.65 / $101.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.20 / $75.29 / $173.14