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Maryland rates for HCPCS L5697

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $53.70 / $85.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $102.33 / $154.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $72.44 / $74.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $52.48 / $79.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $87.10