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Kentucky rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $363.08 / $478.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $588.84 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $346.74 / $380.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $776.25 / $1,000.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $707.95 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $537.03 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $380.19 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $380.19 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $309.03 / $457.09