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Washington, DC 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
$212.17 / $212.17 / $212.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.17 / $212.17 / $212.17
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.00 / $213.00 / $213.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $223.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.73 / $258.73 / $790.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $198.59 / $281.33