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Maine rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.66 / $367.89 / $367.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.82 / $629.41 / $1,166.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.45 / $319.05 / $410.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $401.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $362.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.26 / $442.26 / $442.26
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.57 / $367.89 / $367.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.18 / $328.76 / $626.67