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Maryland rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.21 / $254.20 / $388.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.00 / $261.00 / $332.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.77 / $311.77 / $311.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $227.60 / $311.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.35 / $486.22 / $700.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.69 / $242.57 / $384.64
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.10 / $264.10 / $340.35