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Maryland rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,290.87 / $3,715.35
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,570.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,365.16 / $6,606.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,090.30 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,238.72 / $3,388.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,630.78