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Maryland rates for HCPCS L5649

Addition to lower extremity, ischial containment/narrow M-L socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.46 / $1,278.69 / $2,131.19
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.00 / $1,344.40 / $1,639.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $1,800.00 / $1,800.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,314.00 / $1,800.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,679.28 / $2,398.96 / $3,454.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.04 / $1,261.99 / $1,897.83
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,382.85 / $1,382.85 / $1,711.10