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Washington, DC rates for HCPCS L5655

Addition To Lower Extremity Socket Insert Below Knee (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.64 / $179.64 / $179.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.64 / $179.64 / $179.64
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.00 / $188.87 / $230.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $161.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.06 / $219.06 / $669.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.09 / $168.14 / $238.20