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Maryland rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.09 / $309.02 / $468.48
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.00 / $314.00 / $400.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $276.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.16 / $585.94 / $843.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.93 / $306.94 / $463.54
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.55 / $354.55 / $410.16