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Maryland rates for HCPCS L5639

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.94 / $730.39 / $1,095.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.00 / $735.00 / $936.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.47 / $635.47 / $870.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.20 / $1,370.29 / $1,973.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.24 / $717.80 / $1,084.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.29 / $814.29 / $959.20