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Maryland rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.28 / $226.72 / $410.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $248.00 / $248.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.64 / $462.35 / $665.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.27 / $238.59 / $365.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.07 / $264.07 / $323.64