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Maine rates for HCPCS L5987

All lower extremity prostheses, shank foot system with vertical loading pylon

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.46 / $5,708.70 / $5,708.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,538.71 / $9,767.10 / $18,105.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,950.71 / $4,950.71 / $6,363.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,942.27 / $6,042.00 / $6,229.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $4,410.66 / $6,042.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,862.77 / $6,862.77 / $6,862.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,772.64 / $5,708.70 / $5,708.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,819.11 / $4,228.67 / $9,724.62