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Maine rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.00 / $218.89 / $218.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.06 / $374.51 / $694.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.22 / $155.55 / $244.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $159.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.14 / $263.14 / $263.14
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.01 / $218.89 / $218.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.10 / $183.23 / $372.88