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Connecticut rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.65 / $246.65 / $246.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.07 / $206.35 / $246.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.28 / $507.46 / $580.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.11 / $266.11 / $278.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.85 / $329.85 / $329.85
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.38 / $329.85 / $432.23
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.25 / $277.25 / $277.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.20 / $253.17 / $335.50