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Washington, DC rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $3,981.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $3,715.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $7,244.36 / $10,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,630.27 / $3,890.45