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Maryland rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.44 / $140.44 / $210.66
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.30 / $160.30 / $180.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $159.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $159.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.44 / $263.49 / $379.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.69 / $135.97 / $208.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.50 / $147.50 / $184.44