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Maryland rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $2,691.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,737.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,951.21 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,089.30 / $2,137.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,479.11 / $2,290.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,454.71