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Maine rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.49 / $194.98 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.48 / $333.59 / $618.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.93 / $142.81 / $217.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $212.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $169.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.40 / $234.40 / $234.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.01 / $194.98 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.29 / $147.46 / $332.15