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Maryland rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.37 / $119.29 / $199.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $125.41 / $152.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $124.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.65 / $223.79 / $322.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.81 / $126.14 / $177.04
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.41 / $135.41 / $156.65