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Maryland rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.76 / $74.00 / $120.66
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.25 / $84.25 / $84.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.64 / $150.91 / $217.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.98 / $77.76 / $119.40
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.58 / $83.58 / $105.64