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Maryland rates for HCPCS L5987

All Lower Extremity Prosthesis Shank Foot System With Vertical Loading Pylon

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,637.28 / $4,156.35 / $6,776.93
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,731.93 / $4,750.10 / $5,794.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $6,042.00 / $6,042.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $4,410.66 / $6,042.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,933.33 / $8,476.19 / $12,205.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,818.12 / $4,356.02 / $6,705.53
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,694.43 / $4,694.43 / $5,933.33