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Connecticut rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.07 / $319.07 / $319.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.39 / $301.89 / $326.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$508.77 / $656.48 / $751.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.40 / $352.40 / $369.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.71 / $426.71 / $426.71
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.92 / $426.71 / $558.01
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.74 / $388.74 / $388.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.03 / $382.03 / $382.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.94 / $327.51 / $445.50