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Maine rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.75 / $2,922.20 / $2,922.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,858.95 / $4,999.62 / $9,267.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,469.21 / $2,604.23 / $3,257.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $3,188.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $1,861.53 / $2,550.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,512.95 / $3,512.95 / $3,512.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,443.04 / $2,922.20 / $2,922.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,568.67 / $2,164.59 / $4,977.88