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Maryland rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.92 / $315.86 / $457.78
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.00 / $345.00 / $440.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $329.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.91 / $644.15 / $927.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.08 / $332.41 / $509.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.11 / $319.11 / $450.91