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Connecticut rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.95 / $257.95 / $257.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.76 / $220.07 / $257.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$411.32 / $530.74 / $607.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.07 / $240.07 / $254.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $306.16
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.98 / $344.98 / $344.98
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.00 / $344.98 / $451.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.88 / $252.88 / $252.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.07 / $264.77 / $314.95