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Connecticut rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.15 / $184.15 / $184.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.51 / $178.24 / $184.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.64 / $378.89 / $433.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.58 / $201.58 / $203.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $221.07
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.28 / $246.28 / $246.28
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.28 / $265.22 / $376.81
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.28 / $214.28 / $214.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.25 / $189.02 / $244.74