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Maryland rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.10 / $618.22 / $1,008.02
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.00 / $676.00 / $861.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $957.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.14 / $699.14 / $957.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.54 / $1,260.77 / $1,815.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.71 / $628.98 / $997.39
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.90 / $661.90 / $882.54