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Kentucky 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
$115.72 / $160.54 / $166.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.33 / $165.88 / $182.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.99 / $337.33 / $354.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.77 / $191.21 / $201.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.00 / $475.64 / $556.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.45 / $421.66 / $556.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.07 / $221.07 / $427.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $221.07 / $1,793.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.28 / $214.98 / $268.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.19 / $168.29 / $244.74