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Maryland rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.87 / $586.87 / $586.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.11 / $200.32 / $326.61
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.00 / $219.00 / $279.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $232.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $170.08 / $232.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.95 / $408.51 / $588.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.98 / $203.80 / $319.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.81 / $209.81 / $285.95