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Connecticut rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,443.73 / $2,443.73 / $2,443.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,726.24 / $2,088.40 / $2,443.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,896.65 / $5,027.93 / $5,752.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,396.26 / $2,396.26 / $2,530.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $2,728.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $1,991.56
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,268.16 / $3,268.16 / $3,268.16
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,578.38 / $3,268.16 / $4,273.75
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,789.25 / $2,789.25 / $2,789.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,914.27 / $2,508.38 / $3,117.02