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Maine rates for HCPCS L5925

Addition, endoskeletal system, above knee (AK), knee disarticulation or hip disarticulation, manual lock

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.21 / $271.62 / $271.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.69 / $464.71 / $861.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.35 / $257.35 / $321.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.88 / $260.88 / $296.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.44 / $190.44 / $260.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.52 / $326.52 / $326.52
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.08 / $271.62 / $271.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.02 / $303.14 / $462.70