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Maryland rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.15 / $767.07 / $1,576.05
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.00 / $863.87 / $1,053.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $963.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $703.15 / $963.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.05 / $1,541.50 / $2,219.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.99 / $807.49 / $1,219.49
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.78 / $932.78 / $1,310.28