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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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $245.47 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $512.86 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $275.42 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $363.08 / $512.86
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $177.83 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $251.19 / $338.84