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Maryland rates for HCPCS L4205

Repair Of Orthotic Device Labor Component Per 15 Minutes (Special Coverage Instructions Apply. See Mcm: 2100.4)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.13 / $13.50 / $23.44
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.22 / $22.22 / $22.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $16.22 / $22.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.39 / $29.13 / $43.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.11 / $14.37 / $22.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.09 / $25.00 / $25.00