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Washington, DC 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 / $223.87 / $338.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $323.59
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 / $389.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $660.69 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $239.88 / $354.81