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Mississippi 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
$190.55 / $190.55 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $181.97 / $295.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $218.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $218.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $269.15 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $162.18 / $245.47