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Maine rates for HCPCS L5850

Addition, endoskeletal system, above knee (AK) or hip disarticulation, knee extension assist

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.09 / $103.41 / $103.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.56 / $176.92 / $327.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.24 / $97.98 / $115.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.32 / $99.32 / $112.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.50 / $72.50 / $99.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.32 / $124.32 / $124.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.45 / $103.41 / $103.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.02 / $76.59 / $212.61