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Maryland rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.08 / $518.08 / $518.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.01 / $177.86 / $297.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.00 / $179.00 / $228.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $209.59 / $209.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $209.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.58 / $333.68 / $480.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.27 / $221.96 / $256.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.31 / $172.20 / $263.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.92 / $201.92 / $233.58