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Maryland rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,570.40 / $4,265.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,884.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,677.35 / $6,918.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,467.37 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,344.23 / $3,630.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $3,890.45