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Maine rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.33 / $555.42 / $555.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.49 / $950.30 / $1,761.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.90 / $428.94 / $619.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $606.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $420.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.72 / $667.72 / $667.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.36 / $555.42 / $555.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.29 / $411.43 / $946.15