go back

Maryland rates for HCPCS L5697

Addition To Lower Extremity Above Knee Or Knee Disarticulation Pelvic Band

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.73 / $54.05 / $81.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.00 / $54.00 / $69.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.21 / $60.21 / $60.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $43.95 / $60.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.98 / $101.40 / $146.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.67 / $51.52 / $79.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.31 / $58.31 / $70.98