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Maine rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,528.10 / $2,355.50 / $2,355.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,110.59 / $4,030.05 / $7,470.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,055.03 / $2,097.52 / $2,625.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $2,400.00 / $2,570.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.00 / $1,752.00 / $2,400.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,831.69 / $2,831.69 / $2,831.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.26 / $2,355.50 / $2,355.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.21 / $1,744.81 / $4,012.53