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Maryland rates for HCPCS L5613

Addition To Lower Extremity Endoskeletal System Above Knee- Knee Disarticulation 4 Bar Linkage With Hydraulic Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.48 / $1,567.83 / $2,795.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,577.00 / $1,648.40 / $2,010.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.78 / $1,902.78 / $1,902.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.03 / $1,389.03 / $1,902.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.00 / $2,941.43 / $4,235.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.97 / $1,547.35 / $2,326.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,779.88 / $1,779.88 / $2,059.00