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Maryland rates for HCPCS L5683

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socket Insert For Other Than Congenital Or Atypical Traumatic Amputee Siliconegel Elastomeric Or Equal For Use With Or Without Locking Mechanism Initial Only(For Other Than I Nitial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.09 / $760.00 / $1,239.18
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.24 / $865.24 / $1,059.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.52 / $950.52 / $950.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.88 / $693.88 / $950.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,084.93 / $1,549.90 / $2,231.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.15 / $799.82 / $1,226.11
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.60 / $858.60 / $1,084.93