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Maine rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,238.72 / $6,606.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $5,128.61 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,162.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $2,454.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $4,466.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,570.40 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,951.21 / $4,168.69